t intervals for massage and douching. Above the age of six,
the choice lies between osteoclasis and osteotomy. In performing
osteotomy the bone is either simply divided or a segment is resected.
The fibula can usually be forcibly straightened, but may require to be
divided through a separate incision. In aggravated cases it may also
be necessary to lengthen the tendo Achillis.

The deformities of the bones of the leg in _inherited syphilis_,
_ostitis deformans_, and _osteomalacia_ have already been described.

#Congenital Deficiencies of the Bones of the Leg.#--The _tibia_ may be
absent completely or in part, more often on one side than on both
sides. In either case the leg is short and stunted, the knee is
flexed, the foot occupies the position of extreme equino-varus, and
the limb is useless. The extent of the defects is demonstrated by the
Roentgen rays. Among other defects with which it may be associated,
absence or deficient development of the patella is the most frequent.
When the upper end of the tibia is absent, the fibula articulates with
the lateral condyle of the femur. The operative treatment aims at
correcting the flexion at the knee, the equino-varus deformity of the
foot, and at substituting the fibula for the absent tibia. The
deficiency of the upper end may be compensated for by implanting the
head of the fibula between the condyles of the femur, and that at the
lower end by splitting the fibula so as to form a socket for the
talus. Amputation should be avoided, as even a dwarfed leg and foot
improves the service of an artificial limb. A modification of the
O'Connor extension boot may be employed.

The _fibula_ may be absent completely or in part. The clinical
appearances depend upon the condition of the tibia. When the tibia is
normal, the most notable feature is the absence of the lateral
malleolus, and the extreme valgus attitude of the foot. More commonly
the tibia makes a sharp forward bend just below its middle, and the
overlying skin presents a dimple or scar-like depression. This has
usually been regarded as an evidence of intra-uterine fracture, but
the observations of Hoffa suggest that both the bend of the bone and
the depression on the skin are due to pressure exercised upon the leg
from without by an amniotic band or adhesion. The leg fails to grow,
the deformity becomes more pronounced, and the toes become pointed. If
the tibia is markedly bent, it may be straightened by osteotomy; and