SURFACE LANDMARKS : THE LOWER EXTREMITY. 



669 



inner border of the foot — and thus the first metatarso-phalangeal joint — to excessive 

 pressure. 



Adventitious bursae are found over the external malleolus, — "tailor's bursa," — 

 over the cuboid in equino-varus, and at other points exposed to pressure in the 

 different forms of club-foot. 



Gluteus 

 medius 



Greater 



trochanter 



Gluteus 



maxinuis 



Gluteo-fenioral 

 crease 



Crest of ilium 



Tensor 

 fasciae 

 > i latae 



Vastus externus 



SURFACE LANDMARKS OF THE LOWER EXTREMITY. 



I. The Buttocks and Hip. — The iliac furrow (page 349) indicating the line 

 of the crest of the ilium, with the external oblique above and the gluteus medius 

 below, passes forward to the anterior 



superior spine, and is more or less Fig. 632. 



effaced posteriorly where the crest is 

 covered by the flat tendon of the erec- 

 tor spinae. The posterior superior 

 spine is always indicated by a surface 

 depression. 



In women the continuous layer of 

 fat passing from the loin to the but- 

 tock blends the surface forms of these 

 regions into one uniform curve (Thom- 

 son), and there is no such marked defi- 

 nition of them as is seen in the male. 



The rounded prominence of the 

 buttock (Fig. 632) is due partly to 

 subcutaneous fat, partly to the thick 

 muscular mass of the gluteus maximus, 

 especially developed in man by reason 

 of his assumption of the upright po- 

 sition. It is more prominent posteri- 

 orly, becomes flattened as it passes 

 outward, and ends in a distinct de- 

 pression (Fig. 632) at the tendinous 

 insertion of that muscle just behind 

 and below the greater trochanter. Al- 

 though the trochanter is on a i>lane 

 external to that of the iliac crest, the 

 hollow between it and the ilium is so 

 obliterated by the gluteus medius and 

 minimus muscles that it ordinarily does 

 not appear as a surface prominence. 

 Its upper border — on a level with the 

 centre of the acetabulum — is indistinct 

 on account of the presence of the glu- 

 teus medius tendon which passes over 

 it to be inserted into the outer surface 

 of the trochanter. 



In front the muscular eminences 

 where the region of the buttock passes 

 into that of the hip are due to the glu- 

 teus medius above and more anteriorly 

 to the tensor faciae latae (Fig. 632), 

 which shows as a broad elevation 

 just behind a vertical line drawn 



through the anterior superior spine and just below the forepart of the iliac crest. 

 It can be best seen if the thigh is in abduction and inward rotation. 



As the skin of the buttock is made tense when the thigh is flexed on the pelvis, 

 the /o/d of the nates (gluteo-femoral crease), due to creasing or drawing in of the 

 skin, is formed when the thigh is extended. It begins just below the level of the 



Biceps tendon 



Soleus 



Peroneus 



longus and 



brevis 



Extensor 



brevis 



digitorum 



Extensor longus digitorum 



Lateral surface of right leg, showing 

 modelling on living subject. 



