s
correction, the tendo Achillis should be lengthened.

The turning in of the toes may be overcome by strapping the feet at
night to a wooden board with the whole lower limb rotated laterally so
that the toes of each foot point directly outwards. On account of the
tendency towards relapse, the manipulations and massage must be
persevered with for at least a year.

_Tenotomy and Forcible Correction under Anaesthesia._--In more severe
cases we have to deal not only with the contracted soft parts, but
with changes in the bones resulting from their having grown in
adaptation to the deformed attitude. The majority of surgeons defer
operative measures until the child is about a year old.

The soft parts to be divided are the tendo Achillis, the medial and
posterior ligaments of the ankle, the plantar fascia, the
calcaneo-navicular ligaments, and the tibialis posterior tendon. The
varus deformity may then be corrected by laying the foot on its
lateral side on a padded triangular wooden block, and pressing
forcibly on the anterior and posterior ends of the foot so as to undo
the curve on its medial side and allow of abduction of the foot; this
is usually attended with cracking as the shortened ligaments give way.
The equinus element is next dealt with by forcibly dorsiflexing the
foot until the deformity is over-corrected. If it is preferred to
correct the deformity in stages instead of at one sitting, the equinus
element is left to the last. In older children, the strength of the
hands is usually insufficient to stretch the tissues, and mechanical
wrenches may be employed, such as those devised by Thomas, Bradford,
or Lorenz.

_Resection of a wedge from the tarsus_ (Davies Colley, 1876) is
reserved for the most severe cases in which the shape and rigidity of
the bones prevent correction of the deformity by any other means. The
base of the wedge is on the lateral aspect, and the bone removed
includes parts of the calcaneus, cuboid, talus, and navicular.

_Removal of the talus_ is an alternative operation to resection of the
tarsus, and may yield equally good results.

In children, before the tarsal bones have become completely ossified,
Ogston's method yields good results; instead of removing a wedge from
the tarsus, the osseous nucleus of each bone is gouged out, leaving
the cartilaginous shell. In this way the intertarsal joints are not
interfered with, and the cartilaginous tarsus can be moulded so that
when ossifica