55 



APPLIED ANATOMY. 



tendons of the tibialis posterior and flexor longus digitorum in front of it. Care should 

 be taken that the main trunk is ligated and not one of its plantar branches in case of 

 a high division. 



Peroneal Artery. The peroneal artery is given off from the posterior tibial 

 2.5 cm. (i in.) below the lower edge of popliteus muscle. It follows the inner edge 

 of the fibula beneath or in the fibres of origin of the flexor longus hallucis. If it is 

 desired to ligate it, the incision is to be made over the inner edge of the fibula, the 

 edge of the soleus is drawn inward, the fibres of the flexor longus hallucis divided, 

 and the artery found at the junction of the inner edge of the fibula and interosseous 

 membrane. At the lower extremity of the interosseous membrane the artery pierces 

 it to be distributed to the outer anterior portion of the tarsus and ankle. 



VEINS OF THE LEG. 



The deep veins of the lower extremity accompany the arteries. The femoral 

 and popliteal veins are single, but the arteries below have venae comites. These deep 



veins all have valves and there are fre- 

 quent communications with the super- 

 ficial veins. 



On the dorsum of the foot is a 

 venous arch which unites with the inner 

 dorsal digital vein to form the commence- 

 ment of the internal or long saphenous 

 vein. The outer extremity unites with 

 the outer dorsal digital vein to form the 

 commencement of the external or short 

 saphenous vein. 



The internal or long saphenous 

 vein begins just in front of the inter- 

 nal malleolus, ascends on the inner sur- 

 face of the tibia, passes along the poste- 

 rior border of the internal condyle and 

 thence up to the saphenous opening. 

 In the leg it communicates with the deep 

 anterior and posterior tibial and external 

 saphenous veins and in the thigh with 

 the femoral. At or near the saphenous 

 opening it receives the external super- 

 ficial femoral vein from the outer ante- 

 rior surface of the thigh and the internal 

 superficial femoral vein from the inner 

 posterior portion of the thigh. Not infre- 

 quently one of these lateral branches may 

 be almost as large as the internal saphe- 

 nous itself and may be mistaken for it. 

 From the knee down the internal saphenous vein is accompanied by the internal 

 saphenous nerve. 



The external or short saphenous vein begins behind the external malleolus, 

 ascends alongside the tendo calcaneus (Achillis), thence over the gastrocnemius to 

 empty into the popliteal vein. Its branches anastomose with those of the internal 

 saphenous on the inner side of the leg and it communicates through the deep fascia 

 with the deep veins. It is accompanied by the external saphenous nerve. 



Varicose Veins of the Leg. A varicose condition of the veins of the leg is 

 very common. Often the cause cannot be ascertained, but not infrequently pelvic 

 tumors, and especially pregnancy, produce the condition by obstructing the blood- 

 current. The veins become distended and the valves, of which there are many, 

 become insufficient. This destroys the valvular support of the blood column and the 

 veins become tortuous and inflamed, the walls thicken and may become adherent to 

 the skin. The walls in places give way, causing hemorrhages. They may become thin 



FIG. 563. Varicose veins, affecting especially the inter- 

 nal or long saphenous vein. 



