1 64 ANTERIOR TIBIAL NEUROTOMY. 



ward from a point 6 or 7 cm. above the tibio-astragoloid 

 articulation. 



At a point 8 to 10 cm. above the flexure of the hock make 

 an incision through the skin and subcutis 5 or 6 cm. long 

 over the line of division between the two extensors of the 

 foot. Superficially the operator passes near by the muscttlo- 

 cutaneous division of the anterior tibial nerve, NMC, Plate 

 XXVII, which must not be mistaken for the deep branch. 



The peroneus muscle, MP, Plate XXVII, and P, Plate 

 XXVI, is separated from the extensor pedis longus, KP, 

 Plates XXVI and XXVII, by a strong aponenrotic sheath 

 continuous with the tibial aponeurosis. Penetrate the latter 

 anterior to the aponeurotic partition directly against the ex- 

 tensor pedis, EP. and passing along its posterior border to a 

 depth of 2 to 4 cm., there appears the thin margin of the 

 flexor metatarsi magnus KM, Plates XXVI and XXVII, 

 which lies immediately against the extensor pedis without a 

 visible connective tissue partition but revealing itself by a 

 markedly lighter shade of color and its ready separation 

 with the scalpel from the extensor. The deep branch of the 

 peroneal nerve, NP, Plates XXVI and XXVII, lies loosely 

 imbedded on the anterior side of the margin of the flexor 

 metatarsus facing the extensor pedis, at times visible at the 

 margin, at others placed more deeply reaching in some cases 

 a distance from the margin of 4 or 5 mm. Within this 

 range is seen the slender nerve trunk almost devoid of 

 surrounding connective tissue and measuring about 2 mm. 

 in diameter. Pass the aneurism needle beneath it and re- 

 move a piece 3 to 4 cm. long. Close the cutaneous wound 

 with interrupted sutures and dress antiseptically without a 

 bandage. 



