es most suitable for the
last stages of this operation are those depicted in Fig. 45 (_c_, _d_, and
_e_). The curette, or Volkmann's spoon, we show in Fig. 106.

[Illustration: FIG. 107.--RESECTION OF TERMINAL PORTION OF THE PERFORANS.
The horny sole and the horny frog stripped from off the sensitive
structures. _a_, The plantar cushion; _b, b_, the plantar aponeurosis, or
terminal portion of perforans; _c_, the navicular bone; _d_, interosseous
ligaments of the pedal articulation; _e, e_, semilunar crest of the os
pedis; _f_, inferior surface of os pedis; _g, g_, the sensitive laminae of
the bars; _h, h_, bearing surface of the wall; _i, i_, the sensitive sole;
_k_, the sensitive frog.]

When at all diseased the glenoidal surface of the navicular bone should be
curetted, even to the extent of the removal of the whole of the cartilage.
A healthy, granulating surface is thus insured.

The above figure from Gutenacker's 'Hufkrankheiten' explains shortly the
position of the operation wound and the structures involved, rendering
further description unnecessary here.

The operation ended, the dressing follows. Upon this depends very largely
the ultimate recovery of the patient, for it is only by careful attention
and suitable dressings that effectual repair of the injured structures may
be brought about.

A light shoe is first tacked on to the foot, and those portions of the
horny sole that have been allowed to remain dressed with Venice turpentine,
tar, or other thickly-adherent antiseptic.

The exposed soft tissues are then dressed with pledgets of tow[A] soaked
in alcohol and carbolic acid. This dressing must be allowed to remain in
position, and is kept there by means of a bandage, or the shoe with plates
(Fig. 55) and a bandage over it. No pressure is needed; consequently, the
pledgets of tow must not be too thick.

[Footnote A: When using tow in the form of a pad, it is well to remember
that many small balls of the material rolled lightly in the palm of the
hand and afterwards massed together are far better than one large pad of
the tow taken without this preparation. The irregularities of the wound are
better fitted, and the whole dressing easier remains _in situ_ (H.C.R.).]

In the after-dressing of the wound careful attention must be paid to the
granulating surface. Where tending to become too vigorous in growth it
should be held in check by suitable caustic dressings. At the same time it
must be remembered