Operations for deformity and functional disturbance of the lower limbs<br>What are important in treating the lower limbs, unlike the treatment of the upper limbs, are to secure the stability in the normal limb position and how to treat plantar ulcer. Moreover, these two factors are so intimately correlated with each other that it is necessary to perform the treatment by considering them.<br>a) Peroneal palsy: Transference of the posterior tibial muscle is most common. Elongation of the Achilles tendon is often necessary. Carayon's procedure that transfers the flexor digitorum longus muscle to the extensor hallucis longus and extensor digitorum longus muscles may also be performed.<br>b) In the case where all the muscles at and below the level of the leg except for the triceps surae muscle are paralyzed, tenodesis on the anterior side of the crural bones, involving the crural bones, ankle joint and instep, should be performed, while the triceps surae muscle is split longitudinally into two, one of which is passed on the medial side of the tibia to be transferred to the anterior tibial muscle.<br>c) Paralytic talipes equinovarus: Triple arthrodesis is performed for correction of the varus position. and transference of the posterior tibial muscle for talipes equinus.<br>d) Unstable ankle joint: In the presence of tibial and peroneal paralysis, the stability of the ankle joint may have been impaired over a long period. In such a case the brace will be but on but arthrodesis of the ankle joint may also be considered.<br>e) Neuroarthrepathy (what is called Charcot's joint-like disintegration of tarsal bone) It the stages of disintegration are classed into the stage of development, the stage of coalescence and the stage of reconstruction, it is the stage of reconstruction that is most suitable for arthrodesis of the ankle joint, while no surgery should be performed in the stage of development. Pantalar arthrodesis and talo-tibial fusion by the use of Kunntscher's nail has proved the procedure giving good results.<br>f) Flat foot: If the longitudinal arch of the foot becomes flat due to some cause, flat foot and abductus deformity of the anterior and middle portions of the foot occur, often leading not only to a disturbance in gait but also to incurable plantar ulceration. In such cases, the longitudinal arch of the foot is recontructed by arthrodesis of Chopart joint and the abductus deformity of the anterior and middle portions of the foot are corrected: these operations result in decreased recurrence of the ulcer.<br>g) In the case where marked disintegration of bone is noted in the part from near the Chopart joint to the peripheral area, associated with incurable ulcer, and where it is difficult to perform arthrodesis, Boyd's amputation is indicated.<br>h) Deformity of the metatarsal heads and toes: For the hallux valgus separation of the abductor hallucis muscle, arthrodesis of the IP joint, tenodesis of the extensor muscle, and fusion of the part from the base of the lst metatarsal bone to the Chopart joint should be performed, depending on the condition in each case. In the case where there is disintegration of bone the area around the metatarsal head associated with plantar ulceration, fusion of the metatarsal bones with the toes may be performed.<br>i) Clawtoe: Girdlestone's procedure will do in the case where the contracture is not severe, but elongation of the extensor muscles of the toes and tenodesis to the metatarsal bones must often be additionally performed in the cases with severe contracture.