If the defect has existed from birth, its treat ment is more hopeful than if it has been the result of subsequent paralysis. Indeed if treat ment is begun soon enough, and is patiently carried through, perfect recovery should be obtained.
Treatment.—In all cases two things require to be done The first is, by manipulation to bring the foot into its proper position, and the second is to keep it there.
When the child has been born with the defect, this treatment should be begun immediately. In such a case, then, let the mother or nurse take the foot in the hand, and gently and gradually bring it back to its proper position, retaining it there for a little time. It may not, at first, be possible to bring it quite straight. Let the process be repeated often, but only for a few minutes each time, the muscles of the leg being stroked and handled frequently. It will probably be found that the foot in time can be made quite straight with ease. When this has been accomplished, some apparatus may be adapted for the purpose of supporting the foot in the proper position. A plaster-of-Paris bandage would probably be the best for this purpose, but it must be applied to the foot already thoroughly bent round into the proper position, and the foot must be held so till the bandage is quite set. The plaster will require changing once every two or three weeks, and if, after some months, the proper position is retained after the plaster is removed, a shoe with metal straps, to prevent the recurrence of the deformity, should be substituted and kept in use for a long time. Sometimes it will happen that no amount of force that it is judicious to apply will bring the foot into proper position. Only in such an event is it proper to consider the propriety of cutting the tendons or ligaments that, by their shortness, are keeping the foot in its improper position.
In the case of a child who has acquired club foot in consequence of paralytic disease, such as has been already mentioned, treatment is clearly not so simple. For here, besides the two things already mentioned as necessary to be done in all cases, there is a third, namely the restoration of the paralysed muscles. Whether this is possible or not must be decided for each par ticular case. If it can be clone it is by the use of rubbing, massage, and electricity, begun early and patiently persisted in. If it cannot be
done, then, besides bringing the foot back to its proper position and keeping it there, one must supply some sort of substitute for the weak or powerless muscles. There are some surgeons who make it their special business to treat these and other deformities. They are called orthopvedic surgeons, and, if consulted early enough, such an expert will frequently be able to secure very remarkable results by the fitting of special apparatus to the particular case.
Sometimes the deformity is produced by injuries or burns, causing contractions, stiffness of muscles, and shortening of tendons. In such cases surgical treatment may be necessary, as a preliminary, in order to divide the constrict ing bands or shrunken tendons.
The reason why no time should be lost in attending to a case of club-foot is that, in a paralytic case, or one the result of injury, the healthy muscles, which, by being unopposed, draw the foot up, will in time become shortened and stiff and then the case is aggravated. A second reason is that the bones and joints get in time affected, altered, and render the cure much more difficult.
Flat-foot is a deformity resembling in appearance the second variety of club-foot. The foot loses its arch, and rests on its inner side. Pain and difficulty are experienced in walking, because the small bones of the foot have lost the proper relation to one another, owing to absence of the arch.
Treatment consists in placing a pad inside the boot, so as to support the inner side of the foot and restore the arch. To the inner side of the boot an elastic support may be supplied by india-rubber bands running up to and attached by a metal band round the knee. At the same time friction should be used to the weak muscles of the inside of the leg.
(In-knee, calf-knee, Genu- Vul gum) is due, like flat-foot, to yielding of the ligaments and muscles round the joint. The knee is bent inwards at the joint. It is due to weakness, and is common in badly reared chil dren, who are ill fed and live in a bad atmos phere in confined dwellings. Sometimes it occurs in children even before they have begun to walk; sometimes it arises in growing boys about twelve years of age, as the result of un due exercise, or fatigue in walking or standing, and living in a poisoned atmosphere.