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Fractures of the Bones of the Foot.Fractures of the toes are, of course, readily detected ; the general principles of diagnosis and treatment are essentially the same as already stated in discussing fractures of the fingers. Fractures of the bones which connect the toes with the rest of the foot - corresponding, therefore, with the bones lying between the knuckles and the wrist in the upper extremity-are also recognized in most cases without much difficulty, since the change of form and the grating sensation between the fragments are usually perceptible. Fractures of the foot are usually the result of direct violence, such as the passage of a wagon wheel over the member. They are, therefore, accompanied with severe injury to the flesh ; now the fleshy part of the foot consists largely of ligaments and tendons (sinews) which are extremely important in maintaining the form of the foot as well as in executing the movements of the same. There results, therefore, in many cases serious injury to the form of the foot, as well as considerable impairment of its movements ; permanent stiffness of the joints may also result. Treatment.-The treatment of fractures of the foot varies in details according to the location and extent of the fracture. Certain general principles apply to all such, and may be stated here. The foot must be restored, as far as possible, to its natural form. This is often a difficult matter for one who is not acquainted with the anatomy of the part, because the small bones composing the foot proper, fit into one another in such a complicated way that they can be restored to their natural position only by delicate and skillful manipulation. In all cases the injury will be accompanied by considerable swelling, which increases the difficulty in the recognition and treatment of the fracture. It will be necessary, therefore, after restoring the form of the foot so far as possible, to apply hot fomentations - cloths saturated with hot water and covered with oiled silk or oilcloth-for four or five days, or until the swelling subsides. If the injury be situated below the ankle joint and above the toes, no further dressing is required in most cases ; if the injury be situated in the front part.of the foot, advantage is often derived from the use of a splint. This splint may consist either of one of the usual bandages-glue, starch or plaster of Paris - or it may be made out of a shingle ; the selection of the dressing depends largely upon the circumstances of the case as well as upon the individual preferences of the surgeon. Sometimes especial contrivances are required to hold the bones in position. A fracture of the toe requires merely a small splint of wood, pasteboard or leather, whereby the toe can be kept perfectly quiet in its natural position. It sometimes happens that the extremity of the heel bone is broken off from the foot, either by direct violence or by muscular effort. This broken fragment is drawn out of place by the powerful muscles composing the calf of the leg, which are attached to it. We can readily detect the deformity by simply looking at the heel, and by gentle manipulation can discover that the point of the heel is displaced, and that there is a grating sensation between this and the rest of the foot. In treating this fracture, the first object is to relax the muscles composing the calf; for, until this is done, it will be absolutely impossible to restore and retain the broken fragment in its natural position. To relax these muscles, the knee is bent and the toes of the foot are brought as far backward as possible, so as to bring the foot in a line with the leg ; this raises the heel and relaxes the muscles composing the calf. In order to keep the limb in this position the leg should be enveloped in cotton batting and then covered with an ordinary bandage, which is made to extend from the thigh around the leg so as to keep the knee bent ; it is extremely important that this bandage be continued down the foot as far as the toes, in order to hold the heel well up toward the calf. This position of the limb can sometimes be maintained by careful attention to a simple bandage ; but in most cases it is absolutely necessary to employ some more permanent and more rigid dressing. Numerous mechanical devices have been employed for this purpose ; any one can easily invent such a dressing, bearing in mind the fact that the prime object is to keep the foot as nearly as possible in a line with the leg, so that the heel is brought high up on the limb. A very useful dressing for this purpose is that of plaster of Paris or of starch. This dressing secures perfect repose for the limb. Such a dressing has, however, the disadvantage of unnecessary weight and compression of a large amount of surface. One of the most convenient and simple forms-one which can be readily employed by even inexperienced hands-consists of a leather strap or band, which is fastened around the thigh just above the knee, and from which a tape, or another strap, extends to a hook in the heel of a shoe or slipper; the leathern band around the thigh should be well-cushioned or padded with cotton. The advantage of this dressing consists in its simplicity and ease of application; the disadvantage is the degree of motion afforded to the fragments. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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