PROBLEMS IN THE TREATMENT OF CLUB-FOOT

When not due to faulty technic in applying the plaster cast, which with orthopedic surgeons, at least, should be a rarity, a decubitus appearing on the dorsum of the foot is due to a cutting off of the arterial supply of the area afflicted and the cyanosis of the toes is due to a damming back of the venous return, both of which untoward phenomena are caused by the compression of the soft tissues of the dorsum from the overcorrection. The relief from the condition is to reduce the overcorrection and to fix the foot in a less extreme position.

B. Shall the operation be completed at one sitting or shall the correction be made in stages?

It therefore follows that the amount of overcorrection practicable at any one sitting is primarily dependent upon the circulation and is often considerably less than the maximum. For the best results in club-foot a maximum overcorrection must be secured. If, in a description of their technic, the absence of any specific reference to more than one step in the operation can be held to mean that the entire reduction is to be performed and the foot is to be fixed in the maximum overcorrection at the first and only sitting, then it is not to be wondered at that many of the German orthopedists see a decubitus upon the dorsum of the foot so frequently as to compel them to advocate a change in the technic.

The circulation here as in other forcible operations controls the amount of correction obtainable at any one sitting, and if the latter is not sufficient for a permanent cure the correction must be repeated at suitable intervals until the maximum overcorrection can be safely maintained.

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