Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick.
- Henry Gray
- Date:
- 1883
Licence: Public Domain Mark
Credit: Anatomy, descriptive and surgical / by Henry Gray ; with an introduction on general anatomy and development by T. Holmes ; the drawings by H.V. Carter ; with additional drawings in later editions ; ed. by T. Pickering Pick. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
983/1036 (page 979)
![below this it expands again to be attached to the lower and back part of the os calcis. Seen in profile, the tendon is not straight, but slightly concave—being drawn in bj an aponeurosis which forms a sort of girdle around it. This gir- dle proceeds from the posterior ligament of the ankle; and, though most of its fibres encircle the tendon, some of them adhere to and draw in its sides. All this disappears when the tendon is laid bare by dissection. 118. Tendons behind Inner Ankle.—Above and behind the malleolus intern us we can feel the broad flat tendon of the tibialis posticus and upon it that of the flexor longus digitorum. The tendon of the tibialis posticus lies nearest to the bone and comes well up in relief in adduction of the foot. It lies close to, and parallel with, the inner edge of the tibia, so that this edge is the best guide to it. Therefore in tenotomy the knife should be introduced first perpendicularly between the tendon and the bone, and then turned at right angles to cut the tendon. The tendon has a separate sheath and synovial mem- brane, which commences about one inch and a half above the apex of the malleo- lus, and is continued to its insertion into the tubercle of the scaphoid bone. The proper place, then, for division of the tendon, is about two inches above the end of the malleolus. In a young and fat child, where the inner edge of the tibia cannot be dis- tinctly felt, the best guide to the tendon is a point midway between the front and the back of the ankle. An incision in front of this point might injure the internal saphena vein; behind this point, the posterior tibial artery. lly. Tendons behind Outer Ankle.—Behind the malleolus externus we feel the two peroneal (long and short) tendons. They lie close to the edge of the fibula, the short one nearer to the bone. In dividing these tendons, the knife should be introduced perpendicularly to the surface, and about two inches above the apex of the ankle, so as to be above the synovial sheaths of the ten- dons. Tendons in front of Ankle.—Over the front of the ankle, when the mus- cles are in action, we can see and feel, beginning on the inner side, the tendons of the tibialis anticus, the extensor longus pollicis, the extensor longus digito- rum, and the peroneus tertius. They start up like cords when the foot is raised, and are kept in their proper relative position by strong pulleys formed by the anterior annular ligament. Of these pulleys the strongest is that of the extensor communis digitorum. When the ankle is sprained, the pain and swell- ing arise from a stretching of these pulleys and effusion into their synovial sheaths. A laceration of one of the pulleys and escape of the tendon is extremely rare. The place for the division of the tendon of the tibialis anticus, so as to divide it below its synovial sheath, is about one inch before its insertion into the cunei- form bone. The knife should be introduced on the outer side, so as to avoid the dorsal artery of the foot. [Most of these tendons can be best seen by standing a model on one foot, i. e., in unstable equilibrium.] Now trace the lines of the arteries, and the landmarks near which they divide. 120. Popliteal Artery.—About one inch and a quarter below the head of the fibula, or say one inch below the tubercle of the tibia, the popliteal artery divides into the anterior and posterior tibial. The peroneal comes off from the posterior tibial about three inches below the head of the fibula. Consequently we may lay down, as a general rule, that, in amputations one inch below the head of the fibula, only one main artery, the popliteal, is divided. In amputations two inches below the head of the fibula, two main arteries, the anterior and posterior tibial, are divided. In amputations three inches below the head, three main arteries, the two tibials and the peroneal, are divided. 121. Anterior Tibial Artery.—The anterior tibial artery comes in front of the interosseous membrane, one inch and a quarter below the head of the](https://iiif.wellcomecollection.org/image/b21055105_0983.jp2/full/800%2C/0/default.jpg)
