THE OPERATIVE TREATMENT OF CONGENITAL CLUB-FOOT
Authors: CHARLES OGILVY
Journal: JAMA (1910)

When a number of different operations are devised for the same surgical condition, we may assume, first, that the condition is a difficult one to treat successfully, and, second, that no one operation has proved entirely satisfactory in all cases.This is certainly true of club- foot\p=m-\pes equinovarus.Few if any deformities are mor e difficult of perfect correction, and in few condi- tions, if any, do we see more postoperative relapses.It is not the object of this paper to discuss at length the various operations which have been devised, but rather t o outline the surgical treatment that, from a varied experience with cases personally treated, I have learned to be most satisfactory. WHEN TO OPERATEOperation should be done early.Patients should not be a l l o w e d to remain with deformity for one to two years before a corrective operation is performed.If the patient is seen at birth or a few days later, forcible manipulation and a retention bandage dressing will s u f f i c e .Cases of the severest types of deformity ""'•(•d thus early arc corrected without operation.For '' first three weeks when the skin is soft and tender, ne corrective position should be retained after cor- "'ctivc manipulation by adhesive plaster, which is ap¬ plied "v<|' a gauze bandage.After the third week the J?. c pxid adhesive plaster can be applied directly to '"' sk'n.At the end of the third month, if corree "eatment is still required, a plaster-of-Paris dres _ _v ".»WM "."*."«_"--."Nig,ou1^be employed and this should always extend up I" egroin.It ¡s impossible to prevent the inward rotation :c' '"«a and leg by a dressing that does not extend ^j' )' md th€ kmr joint • Jf at the end o{ the seventh month "' deformity of varus or equinus, or both, are present.|;1"' to contracted structures on the inside of the foot.'" '""faction of the AcbilÜB.then an operation should be Performed.hough there are hone changes in the tarsus, the de- of' Ti! 's fn'°m greai part to the abnormal shortening ."'.'' soft structures.The bone deformities involve P nu'ipally the astragalus, and also to a lesser extent .°8 '"di-is.scaphoid, cuboid and semiliinars.The *Vy remodeling of the foot and ankle, however, does '"'ccssitute any operative bone procedure, as the °8 ai'e comparatively soft, and the deformities are f ,8UC°a s ,n prevent a corrective replacement of the t.rhe greatest difficulty is the correction of the ¡nnUS' .''lis '^d ue to the shortened structures on the tis e ",' ,nt' l0°t, principally the skin, subcutaneous s.| 8Ue and fascia.Unless these are divided it is in pos- 0 .correct the varus.In severe cases, in patients .* '""iiths of age.corrective manipulation by stretch- .o ie structures gives very unsatisfactory results.The g™er border of the foot is short and must be lengthened.i ' ching skin and fascia does not give permanent lengthening.Ol'KKVTivK PHOCEDURE8 |n^; Manipulation.-Ifthe deformity is^but slight, it initie i' ' '"''"'''' by manipulative measu'res with the " at under an anesthetic.Lorenz has emphasized "I ""P'utun.e of this line of treatment.The foot is V a over a «'edge-shaped block, and the varus is first