RECONSTRUCTIVE SURGERY IN PARALYTIC DEFORMITIES OF THE LOWER LEG

¹ Section on Orthopaedic Surgery, The Mayo Clinic.

The foot of man has been gradually developed from an arboreal grasping to a terrestrial weight-bearing member. Changes in bony structure, forced by altered function, have gradually taken place, the heel has lengthened, the tarsal bones have increased in size and significance, while the digits and metatarsals have decreased. The muscles are balancers and have by their action led to structural changes and are prime factors in the stability of the foot of man. When, through paralysis, the muscles lose their tone and power, there may be disastrous sequelae in the foot, and restabilization must be undertaken. Restoration of nerve supply to the muscles by neurotization has not been successful. Tendon transference, whereby the insertion of a functioning muscle is transferred to another insertion, may, in selected cases, do much to restore function. Support by paralyzed tendons, tenodesis, has a limited field. Artificial silk or linen ligaments are not satisfactory in the foot as a rule. Stabilization by means of the bony structure of the foot offers the widest and most useful field for reconstructive surgery, the various and varied forms of arthrodesis, the astragalectomy of Whitman, and the bone-check operations of Campbell and Putti being examples. The combination of tendon transference and arthrodesis to give stability serves both to enhance the value of the tendon transference procedures and the arthrodesis.

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