SURFACE ANATOMY OF THE LOWER EXTREMITY 1337 



The lateral condyle is more easily felt than the medial; both epicondyles can be 

 readily identified, and at the upper part of the medial condyle the sharp adductor 

 tubercle can be recognized without difficulty. When the knee is flexed a portion 

 of the patellar surface is uncovered and is palpable. 



The anterior surface of the patella is subcutaneous. When the knee is extended 

 the medial border of the bone is a little more prominent than the lateral, and if 

 the Quadriceps femoris be relaxed the bone can be moved from side to side. When 

 the joint is flexed the patella recedes into the hollow between the condyles of the 

 femur and the upper end of the tibia, and becomes firmly applied to the femur. 



A considerable portion of the tibia is subcutaneous. At the upper end the con- 

 dyles can be felt just below the knee; the medial condyle is broad and smooth, 

 and merges into the subcutaneous surface of the body below; the lateral is narrower 

 and more prominent, and on it, about midway between the apex of the patella 

 and the head of the fibula, is the tubercle for the attachment of the iliotibial band. 

 In front of the upper end of the bone, between the condyles, is an oval eminence, 

 the tuberosity, which is continuous below with the anterior crest of the bone. This 

 crest can be identified in the upper two-thirds of its extent as a flexuous ridge, 

 but in the lower third it disappears and the bone is concealed by the tendons of 

 the muscles on the front of the leg. Medial to the anterior crest is the broad 

 surface, slightly encroached on by muscles in front and behind. The medial 

 malleolus forms a broad prominence, situated at a higher level and somewhat 

 farther forward than the lateral malleolus; it overhangs the medial border of the 

 arch of the foot; its anterior border is nearly straight, its posterior presents a sharp 

 edge which forms the medial margin of the groove for the tendon of Tibialis 

 posterior. 



The only subcutaneous parts of the fibula are the head, the lower part of the 

 body, and the lateral malleolus. The head lies behind and lateral to the lateral 

 condyle of the tibia, and presents as a small prominent pyramidal eminence slightly 

 above the level of the tibial tuberosity; its position can be readily located by 

 following downward the tendon of Biceps femoris. The lateral malleolus is a 

 narrow elongated prominence, from which the lower third or half of the lateral 

 surface of the body of the bone can be traced upward. 



On the dorsum of the tarsus the individual bones cannot be distinguished, with 

 the exception of the head of the talus, which forms a rounded projection in front 

 of the ankle-joint when the foot is forcibly extended. The whole dorsal surface of 

 the foot has a smooth convex outline, the summit of which is the ridge formed by 

 the head of the talus, the navicular, the second cuneiform, and the second meta- 

 tarsal bone; from this it inclines gradually lateralward, and rapidly medialward. 

 On the medial side of the foot the medial process of the tuberosity of the calcaneus 

 and the ridge separating the posterior from the medial surface of the bone are 

 distinguishable; in front of this, and below the medial malleolus, is the susten- 

 taculum tali. The tuberosity of the navicular is palpable about 2.5 to 3 cm. in 

 front of the medial malleolus. 



Farther forward, the ridge formed by the base of the first metatarsal bone can 

 be obscurely felt, and from this the body of the bone can be traced to the expanded 

 head; beneath the base of the first phalanx is the medial sesamoid bone. On the 

 lateral side of the foot the most posterior bony point is the lateral process of 

 the tuberosity of the calcaneus, with the ridge separating the posterior from the 

 lateral surface of the bone. In front of this the greater part of the lateral sur- 

 face of the calcaneus is subcutaneous; on it, below and in front of the lateral 

 malleolus, the trochlear process, when present, can be felt. Farther forward the 

 base of the fifth metatarsal bone is prominent, and from it the body and expanded 

 head can be traced. 



As in the case of the metacarpals, the dorsal surfaces of the metatarsal bones 



