As using the limb hastens the restoration of function, the child should be got on to his feet as soon as possible.
The spastic form of talipes equino-varus is comparatively rare. The plantar flexors and invertors distort the foot into the equino-varus attitude. The heel is drawn up, the anterior part of the foot is adducted and inverted at the mid-tarsal joint. The muscles are tense and rigid, and the reflexes exaggerated. The condition is frequently bilateral, and is often associated with other deformities of the lower limb and with a characteristic spastic gait. Considerable improvement may be brought about by lengthening the tendons of the shortened muscles. In severe cases it may be necessary to resect a portion of the tarsus.
The occurrence of varus without equinus is so exceptional as not to call for separate description.
Pes Equinus.—This deformity, in which the foot is in the position of plantar-flexion with the heel drawn up and the toes pointed, is nearly always acquired as a result either of poliomyelitis or of spastic paralysis. In typical cases the patient walks on the balls of the toes ([Fig. 145]). It is seldom met with as a congenital condition. Occasionally it is due to nerve lesions such as peripheral neuritis, or to injuries and diseases in the region of the ankle, when the foot has been allowed to remain for long periods in the attitude of plantar-flexion. In a limited number of cases the equinus attitude is assumed to compensate for shortening of the limb.
Fig. 145.—Bilateral Pes Equinus in a boy æt. 7, the result of Spastic Paralysis.
In poliomyelitis the deformity is most often unilateral ([Fig. 146]), while in spastic paralysis it is frequently bilateral ([Fig. 145]), and is usually accompanied by excessive arching of the foot—pes cavus—as a result of plantar-flexion at the mid-tarsal joint, and hyper-extension of the first phalanges and plantar-flexion of the second and third phalanges of the toes—“clawing of the toes.”
