Lower extremity

“ All this while the feet are resting on a board placed underneath them, the lower extremities being thus impeded in their movements, the head falls more and more forward, the muscles of the back are weakened and elongated, while those of the chest derive considerable strength from their constant exercise; the clavicles are unable to support the shoulders in their proper position, and therefore bend, or are forced from their natural situation; the cavity of the chest is diminished, and the founda­tion of numerous disorders is laid. ”

“ The plantar flexors and invertors distort the foot into the equino-varus attitude. The heel is drawn up, the anterior part of the foot is adducted and inverted at the mid-tarsal joint. The muscles are tense and rigid, and the reflexes exaggerated. The condition is frequently bilateral, and is often associated with other deformities of the lower limb and with a characteristic spastic gait. Considerable improvement may be brought about by lengthening the tendons of the shortened muscles. ”

“ The lower extremities resemble the upper very closely in the arrangement of the bones, muscles, arteries, and nerves, though modifications occur, due to the difference in function of the lower limbs. There is one long bone in the upper part or thigh, the femur, and two in the lower part or leg, the tibia and fibula, while over the knee-joint is the patella or knee-cap. The ankle has seven bones and the foot nineteen like the hand. ”

“ In the course of his long evolution from a hairy stock, whether simian as we thought yesterday, or a lower one as Professor Woods Jones suggests to-day, these dorsal surfaces of neck, trunk and extensor surfaces of limbs have been exposed through countless generations of men to vastly more stimuli of friction, pressure, and response, than those of the ventral and flexor regions. ”

“ If the bone is not diseased, but is denuded of flesh all around, it is to be sawn in the same manner, for bones which are disengaged from the other parts all around cannot possibly incarnate. In like manner, the extremity of a bone near a joint, if diseased, is to be sawn off; and often, if the whole of a bone, such as the ulna, radius, tibia, or the like, be diseased, it is to be taken out entire. But if the head of the thigh-bone, or pelvis, or a vertebra of the spine be diseased, we must not attempt to operate upon them for fear of the adjoining arteries. ”

“ If one limb or organ is weaker than the others, it should be strengthened by suitable exercises; and here I would allude to a practice which pervades the civilized world. The left side of the body in the majority is the weaker, and this is increased by the constant use of the right in preference to it. Thus spinal curvature generally takes place towards the right side, and the cause of this is the early and constant use of the right hand and arm in the preference to the left. ”

“ The stroking and pressing with the hands from each opposite side of the lower chest, over the region of the heart and liver inward and upward across the chest.
5. The manner in which the backs of the clutched hands are stroking and pressing downward on each side of the lower back and the spine.
If the hands would stroke over the front of the lower legs and continue straight up over the abdomen and then downward on the backs of the legs instead of upwards; neither the nerves, muscles and vessels of the legs nor the internal organs would be influenced in the proper way. ”

“ Hence if children are set in stocks with their heels touching each other as they sit, and are then made to rise up, till they stand erect, the socket or head of the thigh-bone becomes injured, especially in those children, whose bones are soft; and a shortness of that limb succeeds either by the bending of the neck of the thigh-bone, or by its getting out of the acetabulum; and a consequent rising of one shoulder, and a curvature of the spine is produced from so distant a cause. ”

“ Not only the articulations themselves must be so modified as to bear greater stress, but also the numerous ligaments which hold the parts of each in place. Nor can the bodies of the bones remain unstrengthened; for if they have no more than the strengths needed for previous movements they will fail to bear more violent movements. Thus, saying nothing of the required changes in the pelvis, as well as in the nerves and blood-vessels, there are, counting bones, muscles, tendons, ligaments, at least fifty different parts in each hind leg which have to be enlarged. ”

“ The exciting cause, or that which called her attention to her foot, was the alleged slipping of the tendon of the peroneus longus muscle where it passes under the outer ankle-bone. She had no theory, fancy, or any other sentiment regarding her lameness whatever. She simply dropped her toes when walking, and was obliged to lift that limb very high to advance the foot and prevent stumbling. When, in examining her, I asked her to raise the foot, she was unable to do so. The muscles moving the ankle-joint were powerless. ”

“ We shall learn hereafter that the action of the muscles bears an important part in preserving the symmetry of the spine. Muscular strength comes from bodily activity; hence, one of the best preventives of spinal curvature is daily exercise in the open air.
5. Sprains are produced when the ligaments which bind the bones of a joint are strained, twisted, or torn from their attachments. They are quite as serious as a broken bone, and require careful attention lest they lead to a crippling for life. By premature use a sprained limb may be permanently impaired. ”

“ Of course, as the child stoops forward, the arms hang beyond the centre of gravity, the shoulders are consequently more rounded, the strain on the muscles of the back considerably increased, and if this influence were suffered to continue, a permanent deformity would be the necessary result. ”

“ At each of the digital joints the distal bone, starting from the position of extreme flexion, passes through a variable number of degrees before it reaches the point at which it is arrested by tension of the ligaments. ”

“ The wasting of these muscles is of little importance to us who have no need to use our toes in detail; but it is far otherwise with the deep flexors of the foot and toes which are attached to the leg-bones, and whose tendons pass under the ankle joint and arch of the foot and form their chief support. It is, indeed, from the wasting or inaction of the deep flexor muscles, coupled with the turning out of the toes which fashion has imposed upon us, that the ankle and arch of the foot give way under the changed position of the limbs in girls at puberty, which I have described ”

“ Neither does the limb at the groin admit of flexion as in the sound limb, and the head of the bone is felt at the perineum too prominent. These, then, are the symptoms attending dislocation of the thigh inward. ”

“ Again, the fixation of attitudes of rest, such as lateral curvature, flat-foot, knock-knee, &c., has a similar damaging effect, both on the altered joints and on the body generally, and materially affects the length of life and the capacity of enjoyment of the individual. ”

“ There may be a feeling of weight in the limb, and in the case of the knee and ankle the patient tires on walking and drags the leg with more or less of a limp. Movements of the joint are permitted, but are limited in range. ”

“ The shoulders are stooped, the backbone out of plumb, the chest sunken, the hip bones protruding or twisted from a parallel, the facial muscles are wrinkled and the eyes squinted out of all normal balance. ”

“ Hence, to make larger horns of use, additional sizes must be acquired by numerous bones, muscles, and ligaments, as well as by the blood-vessels and nerves on which their actions depend. On calling to mind how the spraining of a single small muscle in the foot incapacitates for walking, or how permanent weakness in a knee-ligament will diminish the power of the leg, it will be seen that unless all these many changes are simultaneously made, they may as well be none of them made—or rather, they would better be none of them made ”

“ The joints, or rather the ends of the bones which form them, display also in their configuration another use. The nerves, blood-vessels, and tendons which are necessary to the life, or for the motion of the limbs, must, it is evident in their way from the trunk of the body to the place of their destination, travel over the moveable joints; and it is no less evident that in this part of their course they will have from sudden motions, and from abrupt changes of curvature, to encounter the danger of compression, attrition, or laceration. ”

“ The fore extremity of each rib consists not of bone, but of an elastic substance called cartilage. The elasticity of this substance, combined with the oblique position of the ribs, constitutes a beautiful provision, in consequence of which the chest enlarges and contracts its volume, to afford free play to the lungs. ”

“ There are no essential alterations of muscle or tendon except those secondary to the contraction of the joint—namely, an undue tension and prominence of the extensor tendon over the metatarso-phalangeal articulation, and an adaptive deficiency of length in the flexors, which are prevented by the permanently bent state of the articulation from keeping pace in growth with the osseous structures. ”

“ In a work of this limited size the sensibility of the various tissues cannot be fully treated but it should be borne in mind that the integument and the subcutaneous tissue, fat and muscles as well as the tendons, their sheaths, the muscles and periosteum and perichondrium covering the bones and cartilages throughout the body, are all highly sensitive to pain. It is also equally true that the bone substance, the bone marrow, and the cartilages are devoid of any of the four modalities of sensation. ”

“ As for the arms, it is noticeable that they still retain the ordinary mammalian habit in being hairier on the back than on the front; and this also is quite in accordance with our present suggestion, because the same differentiating causes have not worked upon the arm as they work upon the back and legs. The peculiar position of the anterior extremities in man, together with the erect posture, makes the arms come much more frequently into frictional contact with the body or clothing on their inner than on their outer surface. ”

“ Showing A thickening of flexors on front of arm, as forearm is swung forward, and B thickening of extensors on back of arm, as forearm is swung backward.
The muscles of the limbs are almost as numerous as those of the trunk of the body, and even more complex. Most of them, on both arms and legs, are in two great groups—one known as the "benders," or flexors, which, when they shorten, bend the limb ”

“ The relation between the muscle plates and the course of development of the chest is illustrated by the fact that an arrest of development of important muscles often coexists with deformities of the chest. The human limbs are developments from the fin-folds as found in fishes and the human embryo. ”

“ The physiological effects of complete division are that the muscles supplied by the nerve are immediately paralysed, the area to which it furnishes the sole cutaneous supply becomes insensitive, and the other structures, including tendons, bones, and joints, lose sensation, and begin to atrophy from loss of the trophic influence. ”

“ The organs of motion lose their vitality in an equal degree with those of sensation and volition. The movements are slow, tremulous, and uncertain. The erector muscles of the trunk can no longer support it in an erect posture; hence the body is bent forward, and the legs fail in giving their pro­per support. ”

“ The muscle that bends the elbow acts at disadvantage, and this is greatest when the arm is nearly or quite extended, as the angle of action is then least. This disadvantage is further increased by the attachment of the motive muscles near the joint. ”

“ Flabbiness in the muscles often causes this trouble with the feet. "The arches of the foot are maintained by ligaments between the bones, supported by muscle tendons which prevent undue stretching of the ligaments and are a protection against flat-foot." [31] Muscle tissue has an abundant blood supply, while ligaments have very little and soon lose their resiliency if unsupported. ”