Peroneal spastic flat foot.

Frau: the University I)epartment of ()rthopaedzc Surgery. .Uanc/iester Royal Infirmary The acquired deformity of peroneal spastic flat foot has posed many problems since its description by Sir Robert Jones (1897, 1916). Although radiographic anomalies in the tarsus have been emphasised in recent years (Harris and Beath 1948), there is no general agreement on their significance. Opinions on the etiology, mechanism and treatment have shown a wide divergence. On this account I have investigated thirty cases of peroneal spastic flat foot and observed the effects of a standard method of treatment over the course of two years. Among the problems that I have studied are the correlation between physical signs and radiographic findings, and the nature of the muscle pull that produces the deformity. Thirty feet in twenty-seven patients were investigated. Cases of generalised tarsal arthritis, which can give a closely similar picture, were excluded. Although I have not been able to elicit passive inversion when the patient was fully relaxed-a finding considered essential to the diagnosis by Sir Robert jones-the cases have satisfied all the other diagnostic criteria : eversion deformity and pain of recent onset with free ankle movement, but with resistance to inversion by tight tendons on the outer side of the tarsus. Patients with a long history of flat foot with increasing pain and generalised stiffness of the tarsus have been excluded. Patients with bilateral deformity hut unilateral symptoms are included as one case. In the clinical investigation I have taken into account the height and weight, build, psychological make-up, age, length of history and mode of onset, the posture of the foot and state of the arch before treatment, the degree of wasting of the leg, and the presence or absence of other neurological changes. The erythrocyte sedimentation rate and the differential sheep-cell agglutination test have been performed to try to pick up cases of early rheumatoid arthritis. Note has been made of the tendons that appeared, clinically, to be responsible for the deformity. Antero-posterior and lateral radiographs, oblique tarsal views (Seddon 1932) and the posterior axial view favoured by Harris and Beath (1948) have been obtained. Finally, fifty feet from normal individuals aged between thirteen and seventeen have been examined clinically and radiographically to assess the frequency of anomalies of this type in the population. Additional investigations were undertaken in some cases in which the foot relapsed after treatment, and in some showing particularly striking …