54 LANDMARKS MEDICAL AND SURGICAL. 



divided in tenotomy, is about the level of the inner ankle ; 

 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 byan aponeurosis 

 which forms a sort of girdle round it. This girdle 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. 



1 1 8. Tendons behind inner ankle. Above and behind 

 the malleolus internus we can feel the broad flat tendon of the 

 tibialis posticus and upon it that of the flexor longus digi- 

 torum. 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 membrane, which commences about one inch and a 

 half above the apex of the malleolus, 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 distinctly 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. 



119. Tendons behind outer ankle. Behind the mal- 

 leolus 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 tendons. 



Tendons in front of ankle. Over the front of the ankle, 

 when the muscles are in action, we can see and feel, beginning 



