Club foot : its causes, pathology and treatment.

  • Adams, William, 1936-
Date:
1873
Catalogue details

Licence: Public Domain Mark

Credit: Club foot : its causes, pathology and treatment. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    THIS PLATE ILLrSTEATES THE PIEST AND SECOND STAGES OE TREATMENT OE CONGENITAL VARUS, AND EXHIBITS THE REPARATIVE PROCESS IN TENDONS AT PERIODS OE SIXTEEN, TWENTY-THREE, AND THIRTY DAYS AETER OPERA- TION.—BOTH EEET EROM THE SAME CASE—FIGURES DRAWN NATURAL SIZE. Fig. 1 represents the foot at the end of the first stage of treatment, viz., when, after the division of the tibiales anticus and posticus tendons, it has been brought from the position of tahpes varus into that of taHpes equiniis ; and Fig. 2 from the opposite leg of the same infant, represents the foot at the end of the second stage of treatment, viz., when, after the division of the tendo Achillis, it has been brought from the position of talipes equinus into a natural position with respect to the leg, or at a right angle with the leg, the deformity now being cured.^—Figures drawn natural size. SIXTEEN DAYS AETEE OPERATION. Fig. 2. Tendo Achillis, and tibialis anticus tendon of the right foot divided. Fig. 2cc. Divided extremities of the tendo Achillis sixteen days after opera- tion, rather more than half an inch apart; but connected by a tough cyHndrical bond of union, equal in diameter and bulk to the tendon it connects. Fig. 2 a, represents a longitudinal section of the same tendo Achillis. The divided extremities of the tendon a a, are seen rather more than half an inch apart, but connected by a solid bond of new material, or new tendon, imbedded in the lower part of which is a small clot of bloods. The cut extremities of the old tendon retain their abrupt and square outline, and are readily distinguishable from the new tendon, with which, however, they are firmly connected by a very fine dovetailing arrangement of old and new tissue. The microscopical appear- ances from this specimen are represented in Plate II, figs. 1 and 1 TWENTY-THEEE DAYS AETER OPERATION. Fig. 1. Tibiales anticus and posticus tendons of the left foot divided. • a a. Divided extremities of the tibialis anticus, three-quarters of an inch apart, but connected by a solid cylindrical bond of new material, equal in diameter and bulk to the extremities of the tendon it serves to connect. h I. Divided extremities of the tibialis posticus, half an inch apart, but con- nected by a solid cyHndrical bond of new material. THIRTY DAYS AETER OPERATION. Fig. 2. The Tibialis anticus divided. a a. Divided extremities of the tibialis anticus, nearly three-quarters of an inch apart, but connected by a cylindrical bond of new tendinous structure, very nearly equal, in diameter and bulk, to the extremities of the tendon it served to connect. h. The posterior tibial tendon had not been divided in this foot, though the oper- ation had been attempted ; and externally the tendon presented some appearances, leading at first to the supposition that it had been divided. It therefore shows not only that division of the posterior tibial tendon is an operation liable to failure, but that in the present instance its division was not absolutely essential to the cure of the case; and no doubt the operation may be dispensed with in many cases of congenital varus. The case from which these specimens were removed is described in niy work On the Eeparative Process in Human Tendons, Case III. page 12.