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
Catalogue details

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.

    985/1036 (page 981)
    Along the outer side of tlie foot we can feel—1, the external tuberosity of the OS calcis; 2, the external malleolus; 3, the peroneal tubercle of tlie os calcis, one inch below the malleolus, with the long peroneal tendon below it, and the short one above it; 4, the projection of the base of the fifth metatarsal bone. 125. Lines of Joints.—In fat persons the following rules for finding the joints may be of service as regards the surgery of the foot:— The level of the ankle joint lies about half an inch above the end of the inner malleolus. This is worth remembering in performing Syme's amputation. The tubercle of the scaphoid bone is the best guide to the astragalo-scaphoid joint which lies immediately behind it; and the plane of this joint is in the same line as that of the calcaneo-cuboid. Thus a line drawn transversely over the dorsum of the foot, behind the tubercle of the scaphoid, would strike both the joints opened in Chopart's operation. Place your thumb on the tubercle of the scaphoid, and measure about one inch and a half in front: here you find the joint between the internal cuneiform bone and the metatarsal bone of the great toe. This point is useful in Lisfranc's operation, which consists in the removal of the metatarsal bones. The line of the calcaneo-cuboid joint lies midway between the external mal- leolus and the (tarsal) end of the metatarsal bone of the little toe. The projection of the fifth metatarsal bone is tlic guide to the joint between it and the cuboid. Notice that the line of the joints between the metatarsal bones and the first phalanges lies a full inch farther back than the interdigital folds of the skin. This is a point to be remembered in amputating the toes. 126. Dorsal Artery.—The line of the dorsal artery of the foot is from the middle of the ankle to the interval between the first and second metatarsal bones. The artery can be felt beating over the bones along the outer side of the extensor longus pollicis, which is the best guide to it. 127. Bursa.—The synovial sheath of the extensor longus pollicis extends from the front of the ankle, over the instep (apex of the internal cuneiform bone) as far as the metatarsal bone of the great toe. There is generally a bursa over the instep, above, or it may be, below, the tendon. There is often a large irregular bursa between the tendons of the extensor longus digitorum, and the projecting end of the astragalus, over which the ten- dons play. There is much friction here. It is well to be aware that this bursa sometimes communicates with the joint of the head of the astragalus. 128. Plantar Arteries.—The course of the external plantar artery corre- sponds with a line drawn from the hollow behind the inner ankle obliquely across the sole nearly to the base of the fifth metatarsal bone; from thence the artery turns transversely across the foot, lying (deeply) near the bases of the metatarsal bones, till it inosculates with the dorsal arterv of the foot in the first interosseous sjiace. The course of the internal plantar corresponds with a line drawn from the inner side of the os calcis to the middle of the great toe. 129. Plantar Fascia.—To divide the plantar fascia subeutaneously, the best place is about one inch in front of its attachment to the os calcis. This is the narrowest part of it. The knife should be introduced on the inner side; and the incision will be behind the plantar artery. The subcutaneous section of the tendon of the abductor pollicis should be made about one inch before its insertion. [It is evidently the opinion of shoemakers that the axis of the sole of the foot ought to be a median straight line, and the two borders symmetrically curved towards it. If a foot they have not unduly distorted be observed care- fully, it will be seen (B. Lee) that the axis i3 curved; that on the inner border of the foot, the heel, and the front part of the foot are in nearly a straight line, while the outer border is a curved line. If nature be followed, natural shaped feet will be the result, and the miseries of corns and bunions be unknown.]