=Scarpa’s Shoes= are instruments for restoring deformed feet to their natural shape. The shoe (fig. 69) consists of a flat metal sole broader and longer than the foot, furnished with a rest for the heel. A rod, attached to the side of the sole beneath the ankle, reaches up the limb, to which it is secured by one broad band and buckle below, and by a second above the knee, opposite which joint the iron stem moves on a free joint backwards and forwards. Opposite the malleoli are set the centres of movement required for the restoration of the deformity; they are moved by a key. The foot is fastened to the sole by straps across the instep and ankle; the toes are restrained by a strap passing round them and fixed to a horizontal toe-bar by the side of the foot. In fitting one of these shoes, which of course must always be made specially for the limb it is to control, the points to be attended to are—1st, the centres of the joints must be so arranged that, when traction is made, the foot shall revolve back again round the same centres it has passed in reaching its distortion. For example, if the heel is raised, as in talipes equinus, the fore part of the sole of the shoe must be capable of elevation, by moving a joint that rotates in a plane parallel to the rotation of the astragalus on the tibia. In most cases of talipes, the bones of the foot have been displaced round several centres; hence, the apparatus must be furnished with power of traction along all of these, or along the lines resulting from these different directions acting simultaneously. 2nd. The heel must be got thoroughly into its place at the back of the sole to ensure that the foot will follow the shoe in all its movements. The treatment of talipes frequently requires division of tendons before extension is attempted, if they are too firmly contracted to permit the bones to regain their proper position until they are lengthened by division. Thus, in varus, the tibiales and tendo achillis; in valgus, the peronci; in equinus, the tendo achillis; are often divided. The limb must not be very tightly braced into the shoe, slight tension, if continuous, suffices to overcome the resistance; and in children if the straps are drawn tight the skin almost invariably inflames, and even sloughs where it is compressed. Before the instrument is applied, the limb should be bandaged with a soft cotton, or Domett’s flannel roller. The foot is first fixed to the sole or shoe, and then the leg to the rod. Traction is increased gradually with frequent small alterations, as the foot yields to the tension and regains its natural position. The accompanying figure (No. 69) represents an instrument made by Mr. Heather Bigg. It shows the shoe restoring a much elevated heel to its proper position after division of the tendo achillis.