1. In a club foot the small inverted and elevated heel is considered to be the most important deforming influence in preventing complete correction and in promoting relapse.

2. Correction of the varus and an increase in the vertical height of the heel are achieved by opening up the medial aspect of the calcaneum and inserting a wedge of bone. This abolishes the inverting action of the calcaneal tendon and brings the heel down on to the ground directly under the line of the tibia so that it touches first in walking. The weight is then shifted on to the forefoot, as in the normal gait, thus producing gradual correction of supination and adduction.

3. The operation may have to be repeated, but with the varus fully corrected and a plantigrade heel there is no chance of relapse, and progressive improvement, not only in gait and shoe wear but also in the development of the foot and leg, can be expected.

4. Skin closure is a difficulty, and though the resulting scar is sometimes conspicuous, it is masked to some extent by being on the postero-medial aspect of the ankle.

5. The ideal age for the operation is about three to four years, but there is virtually no upper age limit.

6. In older patients presenting severe residual deformity it may be necessary to correct the heel and then the equinus of the forefoot by a tarso-metatarsal wedge, thus avoiding damage to the mid-tarsal and subtalar joints.

7. By adopting these principles, soft-tissue release operations, so often disappointing and sometimes damaging, can be avoided and in no patient should there ever be the need to resort to the mutilating "triple wedge" resection.

8. The most important feature of the operation is correction of the varus; it is better to over-correct than to under-correct (Figs. 20 and 21). It is a simple matter to deal with the valgus later if necessary.

1 . A new surgical approach to the treatment of pes cavus is suggested. The operation consists in a subcutaneous division of the contracted plantar fascia and correction of the varus deformity of the heel by removing a wedge from its lateral aspect. It is submitted that, by approaching the deformity from behind and overcoming the varus of the heel, the foot is rendered plantigrade and that thereafter weight bearing exerts a corrective influence which results in progressive improvement of the deformity. The operation is essentially a prophylactic one and, for the best results, it should be performed before there is gross structural deformity and while active growth is still taking place.

2. Even in patients over the age of fourteen, improvement is obtained by doing nothing more than this simple operation. In the presence of fixed deformity of the forefoot, as encountered in older patients, inversion is corrected by removing a lateral wedge from the calcaneum and the cavus by taking a dorsal wedge from the tarso-metatarsal region. This has the double advantage of producing good correction of deformity, while at the same time preserving movement at the mid-tarsal-subtalar joint. Fixed clawing of the toes will require appropriate corrective treatment, but if the toes are malleable the simple effect of weight bearing on the plantigrade foot produces gradual correction.

1. The late results in nineteen cases of total excision of the carpal scaphoid bone for ununited fracture have been reviewed.

2. The results are least satisfactory when there is clinical evidence of arthritis on the dorsal aspect of the wrist, or subluxation of the os magnum and semilunar. In other cases good results usually can be expected.

3. The operation must be done carefully without injury to the neighbouring bones and ligaments. Total excision is preferable to excision of the proximal pole alone.