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On The Articulations   


dislocation, persons rest their weight more on the heel than on the
anterior part of the foot, for the fore part of the foot cannot be
bent forward equally well when the rest of the limb is extended as
when it is in a state of flexion; neither, again, can the foot be
arched to the same degree the limb is bent as when it is extended. The
natural state of matters is such as has been now described; and in
an unreduced dislocation, persons walk in the manner described, for
the reasons which have been stated. The limb, moreover, is less fleshy
than the other, at the nates, the calf of the leg, and the whole of
its posterior part. When this dislocation occurs in infancy, and is
not reduced, or when it is congenital, in these cases the bone of
the thigh is more atrophied than those of the leg and foot; but the
atrophy of the thigh-bone is least of all in this form of dislocation.
The fleshy parts, however, are everywhere attenuated, more
especially behind, as has been stated above. If properly trained, such
persons, when they grow up, can use the limb, which is only a little
shorter than the other, and yet they support themselves on a staff
at the affected side. For, not being able to use properly the ball
of the foot without the heel, nor to put it down as some can in the
other varieties of dislocation (the cause of which has been just now
stated), on this account they require a staff. But those who are
neglected, and are not in the practice of putting their foot to the
ground, but keep the limb up, have the bones more atrophied than those
who use the limb; and, at the articulations, the limb is more maimed
in the direct line than in the other forms of dislocation.

61. In a word, luxations and subluxations take place in different
degrees, being sometimes greater and sometimes less; and those cases
in which the bone has slipped or been displaced to a much greater
extent, are in general more difficult to rectify than otherwise; and
if not reduced, such cases have greater and more striking impairment
and lesion of the bones, fleshy parts, and attitudes; but when the
bone has slipped, or been displaced to a less extent, it is easier
to reduce such cases than the other; and if the attempts at
reduction have failed, or have been neglected, the impairment in
such cases is less, and proves less injurious than in the cases just
mentioned. The other joints present great differences as to the extent
of the displacements which they are subject to. But the heads of the
femur and humerus are very similar to one another as to their
dislocations. For the heads of the bones are rounded and smooth, and
the sockets which receive the heads are also circular, and adapted
to the heads; they do not admit then of being dislocated in any
intermediate degree, but, not withstanding, from their rounded
shape, the bones slip either outward or inward. In the case we are now
treating of, then, there is either a complete dislocation or none at
all, and yet these bones admit of being displaced to a greater or less
extent; and the thigh is more subject to these differences than the
arm.

62. Wherefore, then, some of these congenital displacements, if to a
small extent, may be reduced to their natural condition, and
especially those at the ankle-joint. Most cases of congenital
club-foot are remediable, unless the declination be very great, or
when the affection occurs at an advanced period of youth. The best
plan, then, is to treat such cases at as early a period as possible,
before the deficiency of the bones of the foot is very great, and
before there is any great wasting of the flesh of the leg. There is
more than one variety of club-foot, the most of them being not
complete dislocations, but impairments connected with the habitual
maintenance of the limb in a certain position. In conducting the
treatment, attention must be paid to the following points: to push
back and rectify the bone of the leg at the ankle from without inward,
and to make counter-pressure on the bone of the heel in an outward
direction, so as to bring it bring it into line, in order that the

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