_ the toes are pointed upwards and the foot rests on the heel.
This is always an acquired (paralytic) deformity.

The treatment of congenital club-foot, which is almost invariably
_varus_ or _equino-varus_, should be begun as soon as ever the abnormal
condition of the foot is recognized. The nurse should be shown how to
twist and coax the foot into the improved position, and should so hold
it in her hand many times a day. And thus by daily, or, one might almost
say, hourly manipulations, much good may be accomplished without
distress to the infant. If after weeks or months of these measures
insufficient progress has been made, the subcutaneous division of a
tendon or two, or of some tendons and ligaments may be necessary, the
foot being subsequently fixed up in the improved position in plaster of
Paris. If these subcutaneous operations also prove disappointing, or if
after their apparently successful employment the foot constantly
relapses into the old position, a more radical procedure will be
required. Of the many procedures which have been adopted there is,
probably, none equal to that of free transverse incision introduced by
the late Dr A. M. Phelps of New York. By this "open method" the surgeon
sees exactly what structures are at fault and in need of division--skin,
fasciae tendons, ligaments; everything, in short, which prevented the
easy rectification of the deformity. After the operation, the foot is
fixed, without any strain, in an over-corrected position, between
plaster of Paris splints. By the adoption of this method the old
instrument of torture known as "Scarpa's shoe" has become obsolete, as
have also some of those operations which effected improvement of the
foot by the removal of portions of the bony arch. Phelps's operation
removes the deformity by increasing the length of the concave border of
the foot rather than by shortening the convex borders as in cuneiform
osteotomy; it is a levelling up, not a levelling down.

_Talipes valgus_ is very rare as a congenital defect, but is common
enough as a result of infantile paralysis and as such is apt to be
combined with the calcanean variety. "Flat-foot" is sometimes spoken of
as _spurious talipes valgus_; it is due to the bony arches of the foot
being called upon to support a weight beyond their power. The giving way
of the arches may be due to weakness of the muscles, tendons or
ligaments--probably of all three. It is often met with in feeble and
flabby