The Pathology of Club-foot and 
Electro-Massage Me- 
chanical Treatment oh 
the same! 
BEFORE THE |3 ALTI MO RE JA EDI C A L! I AT ION , 
Regular JVLeeting. jJan. 26, 1874, by jJ. jJ. £aldw£-ll, 
Permit me Mr. President and Gentlemen to occupy a few moments of this pleas- 
ant occasion in considering duplex cases of Club-Foot and their treatment. 
The learned Professor Crosby, before a late meeting of the Pathological Society 
of New York, said; —It is the theory of the Orthopoedists that the atrophy, dimin- 
ished temperature and Cyanotic appearance are due to the bending of the Vascular 
channels out of their natural position, by which both the ingress and the egress of 
blood is much diminished and retarded. If in a case of Congenital Talipes the foot 
is immediately carried into a normal position and retained there, the bent vessels are 
straightened, and the foot and leg may then be fully nourished and Atrophy avoided. 
Theastralagus is so deeply received between the malleoli, and so firmly held by the 
lateral ligaments that the motion of the flexion and extension are alone permitted. 
The ankle is thus seen to be purely a Ginglvmoid (or hinge-like) articulation. 
Our knowledge of Anatomy teaches us that of the twelve muscles passing from 
the leg to the foot, nine are inserted anterior to the medio-tarsal articulation, (or in 
front of the articulation of the last row of Tarsal bones with the upper extremities 
of the meta-tarsal bones); the three remaining muscles, namely:—The Gastrocne- 
mius (or belly muscles) Soleus, (or Sun-fish muscle) Plantaris (or base muscles) are 
all inserted to the tuberosity of the os calcis (or Spur-bone.) It is at the Media- 
tarsal articulation that, the distortion of club-foot occurs. In Talipes Calcaneus the 
ankle is in fault, but in no other variety; and hence here the term, club-foot, is a 
mis-nomer. 
In Talipes Equinus the heel seems to be drawn up, as though the distortion was 
at the ankle; but a careful examination will show that the heel is not drawn up, but 
the foot, anterior to the medio-tarsal articulation, has dropped downward, the result 
of Paralysis of the extensor muscle. 
In the Cavo-Varus, (or twisted arch) the plantar fascia is much shortened and 
contracted, by which the antero-posterur arch of the foot has been exalted, and a 
Talipes Cavusengrafted on the other distortion. In Varus the deformity is due to 
Spastic (or ,jerk-like)'contractions of the anterior tibial, and measurably of the pos- 
terior tibial muscles. The Peroneal,(or fib.ilar muscles) are Paralytic,thus the tibial 
muscles rotate the foot inward; lastly, the tarsal bones, from continued pressure and 
neglect of proper treatment must become permanently misshaped and deformed,hence 
the necessity of remedial efforts, while these plastic tissues are auieniable to restora- 
tion. So much, Mr. President, for Dr. Crosby’s Graphic descriptive Pathology. By 
it we hope to be able sucessfully to illustrate the following typical duplex of Cavo- 
Varus with a satisfactory result: Augusta R. aged 6 years, born of healthy parents and free from hereditary taint, 
presented a few months ago, suffering from congenital club-foot, as above named, 
in the early days of infancy was unsuccessfully treated for this deformity, as this 
Photograph will illustrate. It may be plainly seen that both inferior extremities are 
implicated—First, by the Yarus (or twisted) and superadded to that the Cavus, or 
(arched club-foot). Our mode of treatment was as follows:—First, to tone up these 
paralytic muscles and nerves, and revitalize these atonic vessels, with a view of re- 
establishing nutrition to these parts. We made daily alternating application of the, 
Galvanic and Faradaiccurrents, their values being materially different and essential. 
By the Galvanic current we re-establish the lost temperature and circulation and 
nutrition. By the Faradaic application the muscular irritability and con 
tractions and elasticity are restored. We also ordered the limbs to be shampooed or 
massaged (from the Arab Massa or the Greek verb Masso, to knead.) This treat- 
ment was made famous by Dr. Metzer, of Bonn, in the treatment of Joint diseases. 
His reputation was greatly increased in his successful treatment of the Danish 
Grown Prince. Thus we have combined these modes and term it the Electro-Mas- 
sage Treatment. In this case we also instruct the parent in daily application of 
rubbing the affected part with the Phosphated Oils, another source of nutrition to 
the nerve peripheries, and mobility to the relaxed tissues—furthermore to overcome 
the deformities we apply the club-foot shoe and lateral brace of such construction as 
to give free vascular and muscular action and yet maintain all the parts in a natural 
position, with no Moderate Degree op Success as my late pamphlet will indicate. 
To this little girl we have been able to restore at this early state of treatment, much 
of the rotundity, form and shape of the affected parts. I am encouraged to hope soon 
to be able to present the case to you in persona propria, fully developed. For the 
few cases we have successfully treated by this mode we modestly refer you to the 
pamphlet or the cases related before the faculty of this State at its last Annual Meet- 
ing. 
In Electro-Massage the hand of the operator must be the Electroid, thus each 
faulty weakened muscle must be found, massaged and revitalized. With this little 
patient the treatment has so restored the Dorsalpedes muscles as to have greatly 
elevated the Tarsal bones; by it also the plantar fascia has been expanded, 
lengthened and strengthened, having the effect of lowering and graduating the arches; 
again the tibial and fibular muscles have been so co-ordinated and retoned as to in- 
vert the foot and give a natural rotundity to the legs; indeed we must confess sur- 
prise, especially in this case to have witnessed so rapid and so effectual an issue, for 
there remains none of the coldness, blueness or pale and shriveled appearances, and 
comparatively little of the old distortion. The shoes we believe are the simplest 
used in club-foot troubles, being a modification of Dr. McLean’s excellent apparatus 
as you will see. On the inside of the shoe and fixed to the sole is a sheet of steel or 
metal so reflected as to cover the articulation of the great toe and the neighboring 
parts and attached to middle third of the outer border of the sole (the hollow) is a 
lateral steel splint, light and elastic,extending up to and above the calf,where the leg is 
encircled by another and light steel band. At the base or nearly so is a hinge-like joint 
to work in harmony with the ankle. With this assistance she is enabled to walk to 
and from our office to her home a mile away without pressure upon the old callosi- 
ties on the external border of each foot, upon which she has walked so long and 
painfully in days gone by. The Anatomical plates I offer to illustrate this case, Mr. 
President, is a most excellent one,—from that admirable work on the vascular sys- 
tem, &c., by America’s oldest and noblest Surgeon; I refer, sir, to our own venerable 
Emperor, Nathan R. Smith. 
04 j$T. J3 ALT I MORE.