Premature Ossification of Lower Epiphysis of the Tibia Following Forcible Correction of Clubfeet.
—Riedel1 observed five patients who showed premature ossification of the lower tibial epiphyses following forcible manipulation for the correction of congenital talipes equinovarus. Each patient came under observation because of a persistent tendency toward recurrence of the deformity. In all cases, roentgen-ray examination showed that the lower tibial epiphyses had closed, while the lower epiphyses of the fibula were still open. The tibiae had stopped growing, while the fibulae were still elongating, and the asymmetrical growth resulted in tilting the astragalus and supinating the os calcis and the whole tarsus. In all of the cases the original manipulation had been forcible, the wrench having been used. Presumably the epyphyses had been injured during the procedure. Riedel believed that many cases of recurring clubfoot are to be explained in this manner. He stated that he