Clubfoot

Clubfoot, a deformity of the foot caused by a contracted or shortened condition of some particular muscle or muscles. The malformation is usually congenital, i.e. exists from birth, and if neglected the parts adapt themselves to their unnatural relationship to one another, and the chance of cure becomes increasingly remote. The most common form of congenital clubfoot is called by the surgeons talipes varus. The child walks on the outer side of the foot, and in order to bring about the natural condition of things certain tendons may require to be divided (the tibialis anticus and posticus, and often the tendo Achillis) with a tenotomy knife. After the operation care must be taken to ensure that healing takes place in such a way that the foot is restored to its proper position. In talipes equinus the heel is drawn up by the shortening of the muscles of the calf; in talipes calcaneus, on the other hand, the foot is flexed and the toes lifted off the ground, so that the patient walks on his heel. In talipes valgus the peronei muscles are contracted and the sole of the foot looks outwards. Apart from congenital clubfoot, a paralytic form must be distinguished. Here the mischief is started by a paralysis, affecting some muscle or group of muscles attached to the foot. The antagonists of the muscles involved are now unopposed, and drag the foot from its natural position. In such a state of things operative treatment is less likely than in the congenital disease to be of avail. For, unless there is a restoration of the lost power in the paralysed muscles, there can never be a return to the natural conditions of health.