Observations on forty-five cases of flat-foot : with particular reference to etiology and treatment / by Royal Whitman.

  • Whitman, Royal, 1857-1946.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Observations on forty-five cases of flat-foot : with particular reference to etiology and treatment / by Royal Whitman. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    o In order to understand the etiology of the affection, and that the reasons for the treatment which will be recommended may he made clear, it will be necessary to describe some of the anatomical peculiarities of the foot. The astragalus, when the foot rests upon the ground, is usually held firmly between the tibia and fibula, permitting almost no movement except as a hinge-joint, the lateral movements taking place in the joint btween it and the os calcis, to which it is attached principally by the interosseous ligament. When the foot bears weight the tendency is to abduction, that is, a slight flattening out of the arch, a turning out of the toes, and a tilting of the os calcis over towards the inner side, its anterior extremity turning slightly in- wards and downwards, while the point of the heel turns slightly outwards. There is a slight rotation of the astragalus forwards, downwards, and inwards, so that its anterior extremity, or head, articulating with the scaphoid, becomes more prominent: also a broadening and slight length- ening of the foot. These movements, which nor- mally take place to an appreciable extent, are ex- aggerated in a foot whose muscles are weakened and ligaments stretched from overwork ; thus the anterior extremity of the os calcis falls inwards and downwards, the bone tilts over so that its external tubercle is raised to a considerable angle with the floor. This change would affect the level of the astragalus in its relation to the leg bones, were it not for the fact that its increased rotation allows its outer margin to sink down into the interosseous fossa, pres- sing before it the interosseous ligament, a movement which depresses its external and raises its internal border. The head of the astragalus, in its exageer- ated rotation, presses inwards on the internal lateral, and inwards and downwards on the calcaneo-scaphoid ligaments, while its axis which should be in a line with the second toe, may point inside the great toe.