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.

    9/16 (page 9)
    a relic of the time, now gone by, when the pathology of the dis¬ ease was thought to consist of paralysis of some muscles and con¬ traction of others. In trying to cure the deformed foot it is quite a mistake to divide tendons according to any fixed plan or rule; |i the only wise course is to wait until, during the progress of the foot towards rectification, it becomes evident that some structure is offering a real and invincible resistance to the means employed, and j| then of course that structure, whatever it be, must be divided. It will invaiiably be found that in infants the tendo Achillis is the only tendon requiring division, and that at the very utmost in addition to this the plantar fascia may now and then have to be cut in the way recommended by Buchanan of Glasgow. Having now exhausted the preliminary considerations neces¬ sary to prevent any misunderstanding, we come to describe the procedure which it is my object to recommend. The child, we will suppose, has arrived at about the age of six or nine months, and the parents have had clearly explained to them I the possibilities and the difficulties of the case. The child has all clothing removed from its lower limbs, and is laid upon a small table of the ordinary height, so that the opera¬ tor can finish his work without the fatigue of prolonged and con¬ siderable stooping. A pillow is placed under its head, and chloro¬ form is administered. Children bear chloroform well, and its administration is most desirable, as it renders the limbs passive j and quiet during the rectification and bandaging. The chloroform need not be deeply given, but it must be administered sufficiently i to prevent the child moving during the application of the band¬ ages. The operator grasps, say, the right foot with both hands, back upwards, holding the ankle joint and heel in his left hand, and the front part of the foot in his right hand, with both thumbs pressing on the outer edge of the sole, opposite Chopart’s articula¬ tion, just below the thin scar-like patch of skin usually present on the most prominent part of the dorsum of the foot. Maintaining steady pressure with his thumbs, he now strives by a deliberate, gradually and cautiously increased force, exerted by his hand, to abduct, evert, and pronate the foot, so as to bring it into as natural a position as possible, but without any attempt whatever to bring down the heel. At first the foot yields readily, but soon ceases to move as desired, and the operator becomes conscious that greater force will be needed to effect his object. Kenewing his grasp, if this has been rendered insecure by the improved I position of the foot and wrinkling of the loose skin on the outer I part of the dorsum of the foot, he continues his task by applying, ! with the same steadiness and caution, an increased force, in exactly I the same manner as before. The force is slowly increased, with I every now and then, if there seems to be any danger of fracturing the bones, intermissions of half a minute or so, during which it is merely kept up, and not further increased, until the resistance of i