TREATMENT OF CONGENITAL TALIPES EQUINOVARUS IN INFANCY AND EARLY CHILDHOOD

1. The earlier begun and the more continuous the treatment, the less likelihood of having to resort to braces at a later period.

2. The inward rotation of the tibia on its long axis is usually found in cases which have been allowed to continue into early childhood before attempting correction of the club-foot. Knockknees is also a later development found in the walking period.

3. No case should be left to the nurse or parent to manipulate, neither should they remove or apply fixing dressings and manipulate the foot.

4. With the continuous plaster dressings correction is more quickly attained and the restoring of balance between the adductor and abductor muslces and the reforming of articular facets is more certain, and the maintenance of the position is absolutely under control.

5. The treatment is kept under the control of the surgeon better with plaster-of-Paris dressings than with readily removable dressings.

6. There is less atrophy from plaster than from the restricting bands of braces.

7. With reasonable care cleanliness is maintained and there should be no irritation of the skin where the plaster is not carried above the knee. Excoriations will not interrupt treatment when zinc oxide adhesive plaster is used to protect the foot.

8. A child walks much more comfortably and easily in a well applied plaster dressing than in any confining brace.

9. Adhesive plaster application can be used when the surgeon desires to test the ability of the foot to maintain itself without allowing any loss in the amount of correction attained.

10. Restoring the foot to an apparently corrected position does not constitute a final result.

11. Tenotomies are seldom necessary. When the tendo achillis is tenotomized a most important resisting point toward the correction of the deformity is removed.

12. The division of the plantar and internal ligaments removes an important element in the correction of the abnormal contour of the bones.

13. Open division of structures produces scar tissue which furnishes an added element toward relapse.

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