You're using an outdated browser and can not see this website's design. We've allowed you to access all the content however, so you're not missing anything other than the pretty wrapper. Please download any browser that supports standards to view the full site.
1407 E. Michigan Ave., Jackson 517-784-1142 770 Riverside Ave., Suite 101, Adrian 517-263-3310
CHAPTER XI - Artificial Feet And Legs For Deformities, Paralysis, Excisions, Arrested Growth, Shortened Growth, Etc.
Deformities of the feet or legs may be due to causes congenital, traumatic, or pathological. Appliances for such cases frequently partake of the character of artificial legs and call for the skill of the prothetician.

No matter how greatly distorted, deformed, or weakened one or both legs may be, there is reasonable hope that some appliance can be used that will aid locomotion, hide the affected parts, and restore a fair degree of symmetry to the person.

SHORT LEG. - The most frequent leg abnormality is that of shortening, due to hip-joint troubles in infancy, or to paralysis.

Cut K 1 represents a case of shortened leg caused by hip dislocation. The front of the foot is dropped downwardly to enable the subject to walk on the ball of his foot.

TALIPES-EQUINUS. - Cut K 2 represents a case of talipes-equinus, leg shortened from one to three or more inches, due to paralysis. The ankle joints in K 1 and K 2 were normally strong and the knees and hips under thorough control. Cut K 3 shows an appliance suitable for either of the above cases. It is termed an extension foot, and is constructed from a wooden block, the upper surface shaped to receive the sole of the affected foot, with the front part dropped to a convenient angle (see dotted line). The under surface of the block is connected with the lower part of a rubber foot. The entire structure is covered with suitable leather, the upper of which runs well up on the leg, incasing the entire foot and ankle. Cut K 4 is a shoe, to be drawn over the foot and appliance. It is usually a part of the mate of the shoe worn on the opposite foot, the quarter having been removed and a larger one put on having the shape and dimensions required to fit properly. This alteration in the shoe is easily made, and can be done by any shoemaker at slight expense. The extension, when complete and covered by a shoe, is shown in Cut K 5. Cut K 6 shows it covered with the trousers. Persons with these appliances walk much better than they do with the old style, thick sole and high-heel shoe. They present a better appearance and are far more comfortable.

TALIPES WITH LATERAL WEAKNESS. - Cut K 7 represents a shortened leg with talipes and loss of control over the ankle joint, there being a strong tendency for the ankle to give way sidewise. A suitable appliance is shown in the same cut. It is constructed of wood, carved from a block with naturally curved grains, or made of aluminum, as conditions require. It receives the leg and foot in a comfortable way and holds them firmly in place. The heel and toes are of rubber. Cut K 8 represents the case with appliance in place and wearer walking. In cases of atrophy of the calf, which frequently accompanies these cases, the leg structure can be carved to approximate the contours and dimensions of the sound leg. There will scarcely be an appreciable increase in weight.

TOE SUPPORT. - An appliance of above type is helpful in holding the foot in correct position, and on account of the rigidity of the ankle the wearer obtains toe support that enables him to rise on the ball of the foot when walking. This produces a natural step, avoids limping, and enables the wearer to go up and down stairs and alight on elevations. It also aids him in balancing, and, as the point of resistance at the ball of the foot is in advance of the knee joint, the tendency of the knee to flex is counteracted; this adds materially to the efficiency of the apparatus, giving the wearer a feeling of confidence and security. A person with a paralyzed leg, using ordinary braces, usually finds it necessary to press his hand against his knee joint when his weight is on the affected leg. He does this to keep the knee from flexing and precipitating a fall, but with the appliance just described firmness of the knee joint is obtained by phalangeal support in the foot, and the wearer is not dependent on pressure placed in his knee joint, or on attachments going above the knee.

Cut K 9 shows a shortened leg with hip and knee joints under control; the ankle suffered a loss of strength and required supporting.

Cut K 10 represents a leg shortened by hip-joint trouble in youth, producing a deficiency in length of about ten inches; the knee and hip joints are under control and the bottom of the foot is capable of bearing weight. Cut K 11 represents a leg, designed for each of the above cases, the natural foot is dropped to the greatest angle that can be tolerated and made to rest on an inclined surface at the required distance from the floor. The leg is incased by a socket made of wood and leather. Cut K 12 represents the appliance in place, and Cut K 13 shows the patient properly and neatly attired.

CONGENITAL DEFORMITY. - Cuts K 14 and 15 illustrate the front and side views of a case of congenital deformity. The foot appears to be attached to the external side of the tibia immediately under the fibula. Weight can be borne on the sole only when the foot is held in position. Cut K 16 gives a side view of a suitable appliance constructed substantially the same as K 11. The displaced foot is held firmly in correct position and the wearer walks helpfully and quite naturally.

TALIPES-VARUS. - Cut K 17 represents a case of talipes varus, resulting from paralysis-the knee joint being involved. A suitable appliance is shown in the same cut. Cut K 18 shows appliance in place and the wearer seated; with this appliance the wearer is enabled to walk acceptably.

LEG DEFORMITIES. - Cut K 19 represents a deformed right leg. From the knee down, the leg is diminutive, terminating in a miniature foot, inclined inwardly and backwardly; the shortening due to arrested development amounts to eight inches. Cut K 20 shows a suitable leg. The deformed leg, from the knee down, is received into the socket of the artificial leg and held there comfortably. A rubber foot, with spring mattress placed at the required distance to restore length, fully equipped the child with means of locomotion.

Cut K 21 represents a right-leg deformity; hip, thigh, and knee under normal conditions; the leg from the knee down undeveloped, foot very small, terminating in a great toe growing from the internal side. Cut K 22 shows an artificial leg devised for the case. The deformed leg is received in the socket and laced. The toe is provided with a protecting pocket, the weight is taken partly on the plantar surface of the miniature foot and partly about the leg below the knee and about the thigh. When first applied the leg only reached to the knee, but it was found that there was a weakness in the knee, with a tendency to abduct; knee joints and thigh support were added, which prevented yielding to lateral weakness. Cut K 23 shows the leg applied and the child standing. Since the application of the appliance the child has grown rapidly in stature and weight, well developed, strong and healthy.

Cut K 24 represents a congenital deformity of the right leg, consisting of a malformed foot, miniature leg, and abnormal relations of tibia and fibula. The tibia extends to the ankle, without connecting with the foot. The fibula connects with the foot but not with the leg, the two bones held in positions by cartilage. When standing on the right foot the bones would slide by each other over an inch; there was also lateral weakness, rendering walking impossible without assistance. Cut K 25 represents an appliance constructed for the case, made of aluminum formed to receive the foot and leg in a comfortable way, terminating with a rubber foot. The weight, when standing or walking, was placed on the internal sloping surface of the tibia, immediately below the knee. The socket held the tibia and fibula in position. This appliance has been used for many years, enabling the wearer to engage in arduous labors, and capable of walking great distances without fatigue.

Cut K 26 represents a shortened and malformed leg. The shortening appears to have been located wholly in the leg between the knee and ankle. Cut K 27 represents a suitable leg. It is constructed to receive and hold the deformed member firmly in place. A rubber foot, placed under the foot-rest, gives the required length. The motion in the ankle made is possible to drop the toe to a concealable angle. Although the apparatus had the appearance of a double foot, there was no difficulty in concealing the deformity by the trousers.

Cut K 28 illustrates a deformity of the right leg. The hip and thigh are normal and an undersized foot appears to have grown immediately from the knee. The patient was able to flex and extend the foot the same as a leg, or, in other words, he had an articulation at the junction of the thigh and the foot, the tibial section being absent. Cut K 29 represents an artificial leg devised for the case. It is similar in its general construction to that represented in Cut E 17. The socket of the leg is excavated to receive the foot, the knee joints and thigh supporter give the foot control over the artificial part.

Cut K 30 represents a deformed left leg. From the knee down it was misshapen, contracted, and distorted. Cut K 31 represents a suitable artificial leg applied. The deformed parts were placed well up and out of the way, concealed by the dress.

Cut K 32 represents a deformed lower right leg, very similar to the one just described. The knee, however, admitted of more flexion, and the artificial leg was made to receive the thigh and deformed part in one socket and was held in place by means of a leather sheath passing from the rear and lacing to the front line of the thigh, as shown in Cut K 33.

INFANTILE PARALYSIS. - Cut K 34 represents an undeveloped left leg, the entire limb considerably atrophied and the joints weak, caused by infantile paralysis. Cut K 35 represents an artificial leg especially designed for the case. The deformed leg is received in the socket and laced in place and the foot dropped to the greatest angle of toleration. The thigh piece incases the thigh and the joints support the knee; a rubber foot is placed at the extremity. Cut K 36 presents a side view of a similar appliance with a knee lock, which is necessary in cases of loss of control in the joints.

Cut K 37 represents a deformity of the right leg; the hip, thigh, and knee normal and healthy, but the leg and foot diminutive in size, with foot rotated outwardly. Cut K 38 represents an artificial limb especially devised for the case. The undeveloped leg is received into the socket, the foot protrudes through an aperture on the external side, the knee joints and thigh piece, placed above the knee, give support and strength about the thigh. A rubber foot, with spring mattress at the lower extremity, completes the apparatus and gives the required support.

OBSTRUCTED GROWTH. - Cuts K 39 and K 40 represent cases of obstructed growth, the hip joints normal, the thighs possessing nearly the proper lengths, terminating in short and misshapen legs. Cut K 41 represents a leg suitable for either case. Both these persons were enabled to walk nearly as well as if normal conditions existed. A slight enlargement of the trousers a little above the knee (necessary to accommodate the deformed leg) is the only noticeable difference in the two sides, and that difference so slight as to be observed only by the critical eye.

Cut K 42 represents a deformity consisting of an undeveloped femur and partially developed leg, the knee joint located very close to the hip. A suitable artificial leg is shown in same cut. The wearer walks so perfectly with this leg that his deformity is absolutely concealed.

BOTH LEGS DEFORMED. - Cut K 43 represents a deformity, both legs atrophied, talipes-varus, feet abnormally large. Amputation of both feet at the ankle joint after the Symes method was advised. This was done and the patient obtained a pair of legs, on which he walks and performs labor acceptably. Cuts K 44 and K 45 represent front and side views of a deformity of both feet. From the hips to a little below the calves normal conditions were present; at about the calves there were false joints supplementary to the knee and ankle articulations. These false joints were under poor control, not sufficient to hold the feet in proper position. We advised the amputation of both limbs through the false joints. This was done, and the child had two excellent tibial stumps on which artificial legs, style E 17, were applied and worn with comfort and efficiency.

Cut K 46 represents a case of amputation of right leg and talipes-varus in the left. A suitable artificial leg for the right side and a helpful appliance for the left are shown in the same cut; Cut K 47 shows the limbs applied and the wearer standing erect. The disposition of the leg to rotate inwardly was controlled by the appliance and the leg was compelled to operate in the line of progress.

Cuts K 48 and K 49 represent front and side views of a case of congenital deformity of both legs, rendering walking very difficult and more largely dependent upon crutches than on feet. We advised the amputation of both legs at the calves. The subject submitted to the amputation of the right leg, but decided to retain his left, which appeared to have more sustaining power.

Cut K 50 represents the case after the amputation of the right leg, and Cut K 51 represents him with the artificial leg applied, while Cut K 52 shows him dressed. The condition of the wearer was greatly improved by the removal of the right leg and the application of an artificial one. The improvement would have been carried further if he had submitted to a similar operation on the left side, thereby obviating the outward curve of the lower leg, which is conspicuous even when covered with trousers. Cut K 53 represents a case of paralysis of the right leg, knee slightly flexed. Cut K 54 represents the same with one of our instruments applied; wearer seated. It was constructed with knee joint, provided with automatic lock, preventing flexing with the weight directly over the leg, permitting flexion when the wearer is seated. The foot is held in proper position for standing and prevented from flexing treacherously when walking.

Cut K 55 represents congenital deformities of both legs; branches grew from the inner surfaces of both femurs. That on the right thigh was ten inches in length, on the left not more than two. The knee joints were on the inner surfaces of the ends of the femurs, feet everted and badly formed. In badly formed. In boyhood, locomotion was obtained by moving about on his haunches; later he walked with the aid of crutches, bearing on the ends of his femurs and dragging the deformed legs. For twenty-five years he submitted to these awkward and unsightly means for getting about. His attention was finally called to artificial limbs, and upon consulting well-informed persons he found that he could improve his condition by having the useless parts of the legs removed and artificial ones applied. We indicated points at which amputations could be performed to advantage. After the operations his stumps presented the appearances shown in Cut K 56. We applied a pair of artificial legs, constructed on the plan of those represented in Cut G 8. When dressed, this man had the appearance of a person with natural and well-formed legs. Cut K 57 is taken from a photograph, showing him as he appears in ordinary life.

Cut K 58 represents a case of arrested development. The child was well formed from the knees up, but from the knees down his deformity was pronounced and of a character to render walking impossible. The child managed to get about rather awkwardly with crutches, permitting but little weight to come on his feet. As the joints in the ankles and knees were flexible, and as the feet were small, we found that we could incase the entire legs, provide knee motion, and place rubber feet at suitable distances below the deformed ones. This was done, and the lad was brought to his proper height, making a presentable appearance and walking in a very acceptable way, without the aid of crutches.

He controlled the artificial knee joints by means of his feet and had little or no difficulty in balancing, walking, sitting, rising, ascending or descending steps. Attention was given to ornamentation, and when dressed his deformity was entirely concealed, as shown in Cut K 59.

DROP FOOT. - The drop foot, resulting from paralysis or arrested development, is a frequent infirmity. Usually the leg is of normal length, the knee joints contracted and weak, with loss of control at the ankles and lateral weakness or a tendency for the foot to bend sidewise, either varus or valgus. The only practical manner in which a leg of this sort can be rendered useful is by fixing the ankle joint artificially, thus providing a resistance at the ball of the foot, the concomitant for balancing, maintaining height when walking and serving as a lever for propulsion, and as a counteracting influence to the tendency of the knee to flex. Cut K 60 represents a case of this kind. Cut K 61 represents the appliance we have devised for such. It is practically a form of splint, cast of aluminum to the shape of the leg and foot. The metal is carried under the entire foot, holding it at a proper angle for walking. The front is provided with leather, arranged for lacing. This appliance holds the ankle joint firmly and provides support at the ball of the foot, which is so far in advance of the center of motion of the knee that it prevents the knee from flexing when the weight of the wearer is directly over the foot. Persons with these appliances walk rapidly and quite naturally, seldom requiring any attachments above the knees.

In connection with appliances of this type for paralyzed lower extremities we may quote from the Cincinnati Lancet-Clinic of October 9, 1897. A prominent physician read a paper before the academy regarding the treatment of his own paralyzed leg:

-An illustrated catalogue fell into my hands, in which was pictured, among artificial legs, etc., an apparatus made of aluminum, splint-like in character, with a rubber cushion under the foot to compensate for shortening. It was made for a case of congenital dislocation of the ankle. The more I studied it, the more it appealed to me that such an apparatus could be made for my own comfort. I had reached a period when I was considering amputation and the substitution of an artificial leg for my paralyzed one. Impressed with the illustration of this apparatus, I consulted a friend upon the subject. He was as much impressed with it as I was, but advised me to obtain the opinion of our surgical friends. They were likewise impressed with it and advised that I try the conservative measure first before I resort to the radical one. I went to New York and consulted the maker. After studying my deformity for a few minutes, he stated that an apparatus could be constructed that would materially improve my condition. The appliance was made and worn for four years. But those four years! How can I describe them? Pen and words fail me. It was like a beautiful oasis in a dreary desert of years of suffering. In connection with my deformity there was a weakness of the abductor muscles, which permits of a rotation outwardly of the thigh. This has been overcome by rubber abductor muscles. The one fastened to the outer side of the apparatus crossed the front part of the right thigh, crossing to the left side of the trunk, and is inserted into the harness. The one attached to the inner side of the apparatus is inserted over the right posterior part of the harness, which is suspended from the left shoulder.

-Who are my benefactors? Who are those who have given to me the comfort of four years’ duration, with a bright future of many more? And, within such a short period, free from pain, caused the twenty odd years of suffering to disappear in the dim and misty past?

-Oh, for a trumpet of such power to herald to the world their name, that those who are needy may seek them! But instead, in gratitude do I raise my feeble voice and wish the cup brimful of happiness for the firm of A. A. Marks, New York City.

-’By thy deeds shalt thou be known!’-

KNEE JOINTS LOCKED. - Shortened and paralyzed legs are frequently accompanied with total loss of the power of extension and flexion in the knee joints. In such cases the mechanism of the artificial knee joints is provided with locks that hold the knees rigid when standing or walking. The joints are capable of being unlocked to admit of flexion when sitting.

Cut K 62 represents a shortened, atrophied, paralyzed leg. Cuts K 63 and K 64 show the same case, with apparatus in place. The apparatus consists of a socket that incases the leg, knee joints with locks that support the knee, thigh piece that takes the support about the thigh, and a rubber foot placed under the deformed natural foot in order to obtain the proper length.

LIMITED KNEE MOTIONS. - Cut K 65 represents a shortened leg with limited motion in the knee, the knee capable of flexion, but incapable of extension beyond the angle represented in the cut; the hip normal and the bottom of the foot capable of enduring pressure. Cut K 66 represents an artificial leg suitable for the case. It is made with a wooden socket, fitted to receive the leg. A comfortable shelf is provided for the foot to rest upon.

Knee joints with pawl and rack and thigh piece incasing the thigh are provided. The pawls at the knee joints are operated by levers which pass up the rear of the thigh. When standing or walking, the leg is brought to the point of greatest extension, the pawls automatically drop into the rack and make the leg immovable at the knee.

The moment the wearer is seated, the lever will rest on the chair and force the pawls out of their racks, allowing the knee to flex (see Cut K 67). By this means the wearer is able to walk safely with rigid knee and bend the knee when sitting. The apparatus has a rubber foot with spring mattress placed at the proper distance below the paralyzed one.

UNUNITED FRACTURES. - Cut K 68 represents an ununited fracture of the tibia and fibula at a point a little above the ankle joint. Usually, in cases of this kind, it is deemed advisable to amputate, the wisdom of which we do not question. Occasionally, however, and particularly in the case here illustrated, the horror of the knife kept the patient from submitting to that alternative, and he came to us for help with a dangling foot, under no control whatever. He was young and in good health, and cherished the hope that if the fractured parts were held firmly in juxtaposition, nature might eventually, in her mysterious way, bring about a union. We constructed, an aluminum socket, incasing the leg from the knee down and the entire foot, fixing the ankle. This appliance, shown in Cut K 69, was fitted when the tibia and fibula were in apposition. Weight was communicated from the bottom of the appliance of the leg immediately below the knee. No weight whatever was brought on the foot and no strains permitted to cause the bones to move out of the places in which they were held. The appliance has been worn advantageously for a number of years. The manner in which the wearer gets about, walks, and attends to his vocation is exceedingly gratifying.

Cut K 70 represents an ununited fracture of the right tibia, due to gunshot wound. All efforts to bring about a union failed. The fibula was not injured, but in consequence of failure of union in the tibia it was obliged to do the work of both bones. Being overtaxed, it gradually yielded and became curved, as shown in the cut. The dark spot immediately below the patella represents a deeply indented scar at the point of fracture. Cut K 71 represents a suitable brace for the case, made of wood and leather. A block of wood is excavated to receive the fractured member in its most comfortable position. The leg, when placed in this splint-like appliance, is held firmly by means of lacing. As the injury shortened the leg about one inch, a block of suitable thickness was hinged to the lower extremity of the splint on which the foot rested. Owing to the proximity of the fracture to the knee articulation, it was impossible to construct the brace that would admit of knee motion. The appliance has done its work for a great many years with great satisfaction to the wearer.

FRACTURES KNEE CAPS, ETC. - Resections of knee joints, fractures of knee caps, weakening of the patella ligaments, in fact any ailment that lessens or destroys control over the knee articulation is greatly benefited by appliances similar to that represented in Cut K 72. The socket below the joint is made of wood, with a leather front capable of being laced. The upper socket is made entirely of leather. The knee joints are made with stops, so that extension cannot be made beyond the proper limit. In cases of partly flexed knees, due to knee-joint disease, this appliance can be used to advantage, requiring knee locks in addition.

Comment from follow-up survey
Thanks so much for the brace it really decreases the pain!