Improved method of treating club-foot / by Alex. Ogston.

  • Ogston, Alexander, 1844-1929.
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Improved method of treating club-foot / by Alex. Ogston. Source: Wellcome Collection.

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    tomy occupies the most prominent place in the minds of those interested in the progress of the case. But, in truth, division of resisting structures is one of the smallest and least weighty factors. If we consider for a moment the true pathology of club-foot, we find ourselves in a better position to estimate the difficulties to he overcome and to give a correct prognosis as to the time and trouble that its cure necessitates. In an infant born with the deformity there exists, properly speaking, neither paralysis nor contraction. The whole limb is distorted, and every structure in it contributes its relative share towards producing the deformity. The skin of the foot and leg, if taken off and stuffed, will assume the clubbed form. The muscles, the tendons, the fasciae, the very vessels and nerves, are all altered in length to suit the deformed foot and leg, but no trace of disease, nor of paralysis or contraction, exists in them. If we were to take away all the muscles, fasciae, vessels, and nerves, the bones and ligaments would still exhibit the distorted shape characteristic of the disease ; and if, after removing all the ligaments, we were to articulate to each other the cartilaginous bones that remained, we could do so only in the deformed position. Hence it has to be borne in mind that every structure in the limb, without any exception, contributes its share towards keeping up the malformation, and has to receive its share of the treatment. Certain it is that some tissues, especially the tendo Achillis, require to be cut by the surgeon, because they, from their powerful structure, resist any other means at his command to restore them to the length they must have ere the limb can be brought into a normal posture; but their division is no essential part of the proper plan of cure, and is resorted to only as a convenience, as an adjunct, often a very necessary one, to the treatment. The treatment proper consists in fulfilling the indication of gradually bringing the limb into the right form, and adapting the means of cure so as to fulfil the indication of a gradual moulding of bones, ligaments, muscles, fasciae, nerves, vessels, and skin, into a form that shall approximate, as far as possible, to that of a sound leg and foot. Whosoever treats club-foot on any other plan treats it mistakenly and unscientifically. It is unnecessary here to discuss the question whether club-foot is a result of intrauterine pressure on the foot, or of a non¬ development of the limb through its failing to go through the normal process of unrolling which, in the foetus, proceeds down¬ wards along the whole lower extremity and, from the posture it occupies in the earlier periods of intrauterine life, brings it into the position normal to the mature infant. The grounds on which such a question can be finally decided are not yet sufficiently known; but, so far as regards what has already been said, it is of little moment which explanation is the true one. But it is high time that the obsolete and misleading views regarding paralysis and contraction, so far as they refer to the ordinary typical con-