A. E. Girl 12 years old. Infantile Paralysis with pronated foot. Treated at the New Jersey Orthopedic Hospital and Dispensary. Arthrodesis of Astragalo-Scaphoid Articulation. Treatment. By lengthening the tendo Achilles we relieve the entire situation in these cases. Stretching by the various means such as the Shaffer stretching apparatus will in many instances of a slightly shortened calf relieve symptoms but the condition is very liable to relapse. together a very satisfactory result was obtained as demonstrated by the third photograph. No. 2-2ND CASE, THREE PHOTOS. The second case of which I have photographs is a boy 15 years old treated by me at the New York Orthopedic Hospital, who presented moderately painful pronated feet, head of astragalus of left foot markedly prominent. After thoroughly stretching the left foot to overcome all resistance I performed an arthrodesis at the astragaloscaphoid articulation in July, 1907. These Instead of dividing the tendon structure completely by any one of the various methods advanced, and suturing, I much prefer the method employed at the New York Orthopedic Dispensary and Hospital advanced by Dr. Hibbs, where the tendon is sufficiently lengthened but still contains a strip of tendon structure in continuity photographs were taken in October, 1908, throughout as a nucleus in its repair. I have used this method extensively both at the New York and the New Jersey Orthopedic Hospitals as well as in private work and have yet to be disappointed in its application to these selected cases. Another method which appeals to me as of value in certain cases of relaxed foot, or congenitally weak foot, or the pronated foot as a result of injury or paralysis in cases above eight years of age, is arthrodesis at one or more joints. I have not attempted the operation at the calcaneo-astragaloid joint for pronated flat foot but I have in several instances ankylosed the astragalus and scaphoid with very satisfactory results. The photographs of two of my patients I have to show, one a girl, A. E., 12 years old, treated at the New Jersey Orthopedic Hospital, being a case of infantile paralysis with loss of anterior and posterior tibial power, with partial loss of gastronemius and common extensors of the foot. The astragalus was in firm position in its relation with the tibia. By removing the articulating surfaces between astragalus and scaphoid, adducting the foot So as to bring the flat cut surfaces of the bones when there appeared to be firm bony union and a much better foot than its fellow. I have since heard from him that the foot remains in the same good position and gives him no further concern. No. 3-3RD CASE, TWO PHOTOS. Although I have no photograph to exhibit I wish to make mention of a third case, a boy 16 years old treated by me at the New Jersey Orthopedic Hospital, who presented a marked rigid, painful and pronated foot. After thorough stretching under ether and walking with foot well over-corrected in plaster of Paris followed by a plate worn in his shoe the foot relapsed and upon my advice he consented to the operation of arthrodesis which I performed ten weeks ago. (From the history I learned that the foot had some years previous received a severe wrenching from being caught in a wheel. In this instance the scaphoid was very prominent). I saw the boy this week and found the position excellent and union apparently secure but of course it is too early to form an opinion of the ultimate result. Then there are those cases seen in our busy clinics who do not bear the usual methods of treatment well, cases which H. E. Boy 15 years old. Case of pronated and moderately rigid flat foot treated at the New York Orthopedic Dispensary and Hospital, July, 1907, by manual stretching and arthrodesis of the astragalo-scaphoid articulation followed by steel plate arch support for six months. such an appliance as you see here, composed of a sling with or without elastic webbing included, to be adjusted about the ankle and instep in such manner that when the end is attached to the metal upright, (which is secured to the shoe below and the calf above) furnishes a more or less rigid support to the arch when walking and standing. This sling support can be used in the treatment of club foot by changing the pull from the inner ankle to the outer ankle. ether and application of plaster of Paris casts fixing the feet in over-correction, but stated it was out of the question as she could not take the time from her work as she was the sole support of the family. I applied this method of treatment, which has permitted her to continue in her employment. The pain diminished from the start and at the present time she is entirely free from pain, spasm of the abductors of the foot is absent, and although her feet are not en |