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Club-Foot and Other Similar Deformities

foot, deformity, muscles, disease, edge and raised

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the scientific name of which is Talipes, is a deformity of the foot due to shortening and stiffness of certain muscles and tendons, and accom panying alterations in the position of the tarsal bones and in the form of their joints. Owing to the de formity the person cannot put the foot down on the ground in the usual way, resting on the sole. The foot is so twisted that the person walks on the outside edge of the foot, or on the inside edge, on the heel only or toes only. There are thus several varieties of club-foot, according to the way in which the foot is twisted.

Four general forms are described : (1) in which the outer edge rests more or less on the ground, the inner edge being turned up wards—talipes varus; (2), in which the inner edge rests on the ground, the reverse of (1) —talipes valgus ; (3), in which the heel is raised and only the toes touch the ground, called talipes equinus (Latin equus, a horse), because of its resemblance to a horse's hoof ; and (4), in which the reverse is the position, the front portion of the foot being raised, and only the heel reaching the ground—talipes cal caneus. Besides these there may be other kinds in which there is a combination of two of the different forms described.

All of these forms of club-foot may be con genital, that is, the child may be born with the deformity, or acquired, that is, the affection may be developed after birth. In both cases the disease may be caused by paralysis of muscles or by spasm. Thus take the case of club-foot where the outside of the foot is turned down and the inside up. On referring to the section on the Muscles it will be seen that the muscles that pass from the leg to the outer side of the foot are the peroneals, and that they raise the outer side, while on the inner side the foot is raised by the tibialis anticus. Suppose the peroneal muscles become paralysed, then the foot cannot be raised on the outer side, and there is nothing to oppose the action of the tibialis anticus, which accordingly pulls up the inner side, and so the deformity is produced.

But again, the tibialis muscle may become spasmodically contracted, and by the force of its spasm overcome the action of the healthy peroneal muscles, and so turn the inside of the foot up, producing a like deformity. Similar causes are at work in the production of the other kinds of club-foot.

If the child has been born with the feet in a natural position, and the deformity has come on at some later period of life, the probability is that paralysis is the cause of it, paralysis affecting groups of muscles only, leaving other muscles unaffected. The disease in which, or rather as one result of which, this deformity very often develops, is a disease of the spinal cord, called Infantile Paralysis of Children (see p. 179). This disease may attack children so insidiously that attention is not seriously called to it till grave mischief has been done and perfect recovery imperilled. This is specially likely to occur in children who have not yet begun to walk. In children who are already old enough to walk, the disease is speedily called attention to, for one of its first results is to paralyse one or both of the child's legs, and sudden inability to stand or walk calls immediate attention to the child's condition. In the case of a child, therefore, who has not yet begun to walk, a physician should be consulted without delay, if a notable change is observed in one or both feet, altering the way in which they hang, toes pointing downwards, for instance, or the sole markedly being turned outwards or in wards. A great deal may be lost by neglect to seek advice early, both because the true nature of the disease, causing the deformity, may be discovered in time to prevent so much mischief occurring, as would likely ensue if the disease were overlooked, and also because the earlier the deformity itself is treated the better.

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