club-foot, and 325 were single; and of these, 186 were of the right foot, and 139 of the left.

In Paris, Duval finds, that the cases of single congenital talipes are to those in which both feet are affected as 2 to 1, as is shown in the following table:1

Talipes is probably a more common affection than is generally supposed. No fewer than 12,547 cases are reported as existing in France, or 1 in every 3000 of the population. And in England, I imagine that the number of cases, irrespective of cause, is relatively larger.

TALIPES VARUS.-'Paißòç, kuλλoç, varus, club-foot, klumpfuss, knollfuss, klopfuss, dohlfuss, pied-bot, stréphendopodie.

This is the most common distortion of the foetal foot, and it presents, even more than other varieties of talipes, degrees of distortion. The axis of the foot forms, with that of the leg, an angle, the anterior portion of the foot being inverted.

In the first degree of talipes varus the anterior portion of the foot is drawn inwards by retraction of the tibialis anticus. (Vide fig. 1 and 2.) This is by no means the most common form of varus, but this degree is essentially varus, as stated by M. Jules Guérin.?

In this degree no other

''Traité pratique du Pied-bot,' p. 327, ed. 2, 1843.

2

Sur les Variétés Anatomiques du Pied-bot congénital,' p. 8, 1839.

COMPARATIVE FREQUENCY OF DISTORTIONS.

27

distortion is superadded to the twisting inwards of the foot, but in the other degrees the heel is raised, in addition

Fig. 1.

to the inversion of the foot. Together with retraction of the tibialis anticus, the plantar fascia is occasionally shortened, through which the length of the foot is diminished.

Fig. 2.

In the second degree, the inner edge of the foot is raised, the toes are inverted, and the heel is elevated. The position of the foot is such that a line extending in the long diameter

of the leg, and passing in front of the tibio-tarsal articulation, will fall on the ball of the little toe. (Fig. 3.) The muscles of the calf of the leg and the anterior and posterior tibial muscles are retracted.

Fig. 3.

The third degree is the ordinary form of congenital varus: the foot is inverted, and the inner edge is so raised that the plantar surface describes a right angle or nearly a right angle with the horizon (fig. 4); the dorsum presents outwards, and the heel is elevated; the sole of the foot is shortened, and presents an unnaturally concave and irregular surface. (Fig. 5.) (Fig. 5.) The first phalanx of the great toe is extended by M. extensor proprius pollicis, which is slightly retracted, and the extensor muscles of the foot and the adductors are more retracted than in the second degree.

The fourth degree is an exaggerated form of the last distortion. The toes present upwards and inwards; the

dorsum of the foot outwards and downwards, or forwards; the inner edge of the foot may lie in contact with the inner side of the leg, and the heel is drawn upwards and inwards. (Fig. 6.)

The flexors of the toes are rigidly retracted, as well as the extensors and the adductors of the foot, and also the muscles in the sole are found more or less rigid.

The abductors of the foot are extended; the plantar surface of the foot is abnormally concave, and the length of the

Fig. 6.

foot is diminished, the toes being approximated to the heel. The tendo Achillis is not to be found in the median line of the leg, but lies immediately above the posterior tibial vessels, on the inner side of the posterior surface of the leg.

In the third and fourth degrees of varus especially, the tarsal bones become rotated, by traction of the muscles, on their smaller axes.

The os calcis occupies almost a vertical position, being drawn upwards by the gastrocnemius muscle, and is also slightly rotated outwards.

The astragalus follows the calcaneum, and is slightly rotated outwards, it also undergoes displacement in its vertical axis; its inner surface tending to assume a direction forwards, and its external surface a direction backwards; and, by reason of its position between the malleoli, these are