, the opposing peroneal muscles will shorten, and, in
time, the bones of the tarsus will undergo structural alterations
which will perpetuate the deformity. If, on the other hand, by some
alteration of the boot, the foot is maintained in the attitude of
inversion, the weakened or paralysed tibial muscles are placed in a
much more favourable condition for recovery.

It must be emphasised that no operation should be performed in these
cases until the question whether it be possible or not to restore the
apparently paralysed muscle is settled. The clinical test of the
recoverability of a muscle is to keep it for a long period--six or
even twelve months--in a condition of relaxation. This test should be
made, no matter how many months or years the muscle may have been
paralysed.

The first stage in the treatment, therefore, is the correction of
existing deformity, after which the limb should be kept immovable
until the ligaments, muscles, and even the bones have regained their
normal length and shape. The slightest stretching of a muscle which is
in process of recovery disables it again.

The age of the patient influences the method of treatment. In young
children in whom the structures are soft and yielding, gradual
correction of the deformity is to be preferred to the more rapid
methods employed in older children. The proper sequence consists in
correcting the deformity, providing the simplest apparatus to keep the
limb in good position, preventing erroneous deflection of body weight
during walking, and then allowing the child to grow and develop until
he has reached the age of five before considering such an operation as
transplanting tendons, and the age of ten before deciding to ankylose
a flail-like joint.

_Reposition, Manipulations, Supports._--An attempt is made to correct
the deformity by manipulation, and the proper attitude is maintained
by a mechanical support. If the foot has become rotated so that the
sole looks laterally, the medial side of the boot must be raised, and
an iron worn which extends from the knee down the lateral side of the
leg, to end, without a joint, in the heel of the boot. In pes equinus,
the iron is let into the back of the heel and extends forwards into
the waist of the boot, to keep the foot at right angles to the leg and
to relax the weak extensor muscles.

_Division of Contractions._--Bands of fascia and contracted tendons
which prevent correction of deformity may have to be div