History of the club-foot

The club-foot varus equine is a disease known since the oldest times.
During antiquity, it was not rare that the newborns with a club-foot die by deficiency of care or child murder.

Let us recall that in ancient mythology, Héphaïstos (still called Vulcan or Mulciber), god of Fire, blacksmith and arms manufacturer of Olympe, was a lame god.
Wire of Zeus and Héra (or Héra only according to the versions), Héphaïstos was the only god of hideous appearance among all the immortal ones.
It is known as in Iliade that his/her mother, ashamed of such an ugliness, precipitated it top of Olympe. Another version allots to Zeus this fall, to punish Héphaïstos to have taken the defense of Héra in a quarrel with her husband (Zeus).
Héphaïstos remained however a popular god in Olympe and on earth, in favour of peace. He was the owner of the artisants and the artists, and the guard of the blacksmiths.
In the ancient life, it chaired the ceremony where the children were allowed in the life of the city.

In XIIème century before our era on Egypt a Pharaon carrying club-foot reigned
Siptah
 

Couvercle du sarcophage de Siptah Vue du pied de la momie

Hippocrate was the first to try to understand and treat this disease, and this as of the birth.

“The club-foot is curable in the majority of the cases. Best is to treat this lesion as soon as possible before it becomes a marked atrophy”.

Hippocrate
Médecin Greek,
born on the island from Cos into 460 before our era.
and died in Arissa into 370 before our era.

With the Middle Ages, the club-foot was regarded as a sign of divine origin (thus like a punishment) and had already this negative image.

In 1642, Jusepe de Ribera painted for the viceroy, the duke of Medina of mow Torres, a fabric representing a young beggar carrying a pied bot, fabric currently exposed to the museum of Louvre.
The young disabled person holds a paper on which one reads in Latin “Give me alms for the love of god”.
It is not a question of a club-foot idiopathic but of a neurological club-foot, being integrated in a context of hémiplégie right: one can indeed note a deformation of the wrist and right hand.

The Club-foot, 164 x 94 cm

It is necessary to await XVIème century, with Ambroise Paré and Felix Würtz of Basle, to see appearing new more rational descriptions of the club-foot, and especially of the proposals for a treatment per progressive external application.
Ambroise Paré

The First tenotomy(Glossary)of the tendon of Achilles (complete section of the tendon which draws the heel upwards) was carried out by Lorentz in Frankfurt in 1782. It was followed by Delpech to Montpellier at the beginning of the XIXème century, but the technique was stopped because of the big number of post-operative infections. The treatment was thus primarily orthopedic by external procedure.
On this subject, it is necessary to quote the work of Antonio Scarpa, doctor Italian who proposes since 1803 a work on the manner of correcting the congenital club-foot.

Exemple d'attelle correctrice utilisée par A.Scarpa

Delpech

Jacques Mathieu Delpech, médecin français, né à Toulouse en 1772, mort assassiné en 1832

Talleyrand with water of Aachen in July 1829.
Drawing of the Countess Heather.
Talleyrand was carrying a club-foot varus equine RIGHT.

(National library. Cabinet of the Prints. Ref.: 67.A. 16600 N2 Bénévent).

Orthopedic shoe of Charles-Maurice de Talleyrand.

“The examination of the orthopaedic appliance exposed to the Castle of Valençay brings further information. Over the entire length on the external side of the shoe, the stringer overflowing, is raised, and cut obliquely, to defer the base of lift apart from the axis of the weight of the body and to thus correct the supination by the action of gravity at the time of loading. This device is supplemented by a rigid external buttress going up on the side of the heel, including the malleolus, and upholstered because of the cutaneous wounds which it would have been likely to cause compared to the projection malléolaire. Lastly, exists a clamp runs étreignant the heel and supporting, via an articulation with adjustable thrust, an internal tutor solidarized with the leg by one embraces calf, it also articulated. With that is added a strap in T whose slope fits into the external part of the heel, caps the external malleolus, and, by its two horizontal branches, comes to take support on the internal tutor. Only differs from the model prescribed by R. Ducroquet, the way of connecting the internal tutor to the shoe, the loop which closes the shoe in addition to the lacing, similar to that which exists opposed side, not having in addition to be interpreted as a support of instep of orthopedic indication.
A rectifying apparatus is thus fixed on an orthopedic shoe which proves to be at the same time compensation and correct of a deformation in varus equine of the foot, but whose dimensions in addition exceed much those of an ordinary shoe, at the same time by volume and the length. “

The club-foot of Talleyrand and its association with a syndrome of Marfan
In J.CLAUSTRE “the FOOT Through the HISTORY”, MASSON Paris 1991
(pp. 66-76) by Marius LACHERETZ




In 1831, Stromeyer had the idea to carry out the first tenotomy of Achilles, not by largely opening the skin (what led to an infection), but by an incision of a few millimetres: it was the first percutaneous tenotomy.
The large English surgeon Little itself was treated in this way, learned this technique and brought back it in England in 1837.

It is necessary to read again the book of Gustave Flaubert, Madame Bovary, where Charle Bovary carries out a percutaneous section of the club-foot of Hippolyte, with an immediate good performance…

Gustave Flaubert

Examples of orthopedic equipment for equine club-foot varus, used at the end of the XIXème century and at the beginning of the XXème century.

1908: Description of the anomalies of position of the feet gathered under the term of “club-foot”.
Only figure III (diagram of right-hand side) corresponds to the current denomination of the club-foot (varus equine).

The beginning of the XXème century sees the birth of orthopedic tools for correction of the club-foot such as the machine of Professor F.Schultze, allowing rectifications “forces some”, and probably “in suffering”, of the anatomical deformations.
 
Orthopaedic appliance used at the beginning of the XXème century with the Rizzoli institute.

Here an example of splint used in the year 1930 and the method of installation described by Dr. L.Ombrédanne.

“For setting up well, one will wrap initially the foot of a layer of not very thick wadding, but especially quite uniform.
It is then important, exclusively, to fix the foot well on the sole average year of 8 of figure, carried out with a band of seersucker, without holding any account of the position which the stem legging takes.
It is only at the end of the bandage, whereas the band goes up on the leg until the wanted height, and in the direction indicated on figure 941 that, only one blow, the band will change direction around the stem legging by pointing out this one in suitable position; thanks to its action of powerful lever, the stem legging will give to the plant the orientation in desired hypercorrection.
The splint of Saint-Germain will be carried day and night during four or six months; during several years, one will then apply it during only harmed.
When the child walks, it is good that its boot does not allow the reproduction of the varus. The type of shoe which Lance makes carry out for the children of our service is inspired by the apparatus of Versepuech.

It is a boot armed with a posterior metal blade anchored in the heel; this blade is articulated so as to have a certain mobility in only the plane frontal (fig. 942). The external edge of the sole is thicker than the intern, and a belt solidarizes this external edge with the posterior metal stem.
The port of this special boot is useful only if the reduction by maneouvres external were not perfect and complete. “

The XXème century saw developing surgical techniques of correction increasingly pointed with doctors like Barnett, Codivilla, Brockman, Turco…
In parallel, the orthopedic treatment became softer and codified more and more with Elmsie, Kite then Ponseti and Masse.


Some famous persons carrying club-foot

Lord Byron (George Gordon)
1778-1824

English poet
He always lived very with difficulty this disease, and felt it like a physical and social infirmity.
For this reason he preferred food in Venice, where displacements were done more in gondoles than with foot.
(more on George Gordon Byron)
Sir Walter Scott
1771-1832
English novelist He accepted his disease better, more especially as two of its ancestors of it had been carrying.
(more on Walter Scott)
Talleyrand
(Charles-Maurice de)
1754-1838
French diplomat

He dissimulated the congenital origin of his disease by telling that an awkward nurse had caused an accident in her childhood.
(more on Charles-Maurice de Talleyrand)
(see also: The club-foot of Talleyrand and its association with a syndrome of Marfan)

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