In cases of club-foot use massage on the foot and on the leg up to the knee. A few turnings and flexions are very beneficial.

1 I have often been called to apply massage to a broken limb to relieve the swelling, thus making the injury more accessible to the surgeon.

In cases of "pigeon-toes" use similar treatment as for club-foot, but with the massage extended up to the hip.

Also the following movements :

1. St. turning of the leg outward.

2. St. rotation of ext. leg (semicircle).

3. L. separating and closing of knees.

4. Feet at more than right angle, deep knee-bend, operator supporting chest and back.

Fig. 114. - Forcing a Stiff Elbow-joint.

5. Depression and elevation of legs, the operator turning the feet out as much as possible.

6. L. separating and closing of legs, feet turned out as much as possible.

In cases of flat foot we can, by the new Gefvert splint and our massage and movements, cure the deformity in a short time, if the patient will only persevere and be willing to stand a little pain. Apply careful massage to the whole foot and leg up to the knee. The following movements are very effective :

1. Turning of the foot inward.

2. Rotation of the foot.

3. Flexion and extension of the foot.

4. Walking on tiptoe.

5. Walking on the outside border of the foot.

6. Feet closed ; deep knee-bend.

Fig. 115. - Forcing a Knee-joint.

Try to teach the patient to practice walking on his tiptoes five or six times daily. Massage is a valuable remedy in the complicated local nerve-troubles, so frequently caused by a condition of talipes valgus.

In other deformities of the feet the aim of the treatment must be to work the affected part back to its proper position by turning, rotation, flexion and extension, etc. Local massage is used to invigorate the muscles and to relax contracted tendons.

All the deformities arising from infantile paralysis have been successfully treated by massage.

With a good brace and intelligent massage there is rarely any real need for operating on the tendo-Achillis.