^8 A MANUAL OP ANATOMY 



insertions, this should now be done. The actions of the muscles to which 

 these tendons give insertion should be mastered, with special reference to the 

 different varieties of club-foot, and an articulated foot should be before the 

 dissector to enable him to illustrate these varieties and the actions of the 

 muscles involved in producing them. 



Attention is now to be directed to the remaining articulations, namely, 

 the tibio-fibular joints, the ankle-joint, and the joints of the foot. Before 

 removing the muscles of the front of the leg and the deep muscles of the 

 back, the anterior and posterior relations of the interosseous membrane 

 should be studied, and the muscular relations of the ankle-joint mastered. 

 Thereafter the muscles are to be removed, and attention is to be directed 

 first to the superior tibio-fibular joint. The relation of the tendon of insertion 

 of the biceps femoris to the joint is to be noted, as well as the relation of the 

 tendon of the popliteus. More especially, the relation of the anterior division 

 of the biceps tendon to the anterior ligament of the joint is to be studied. 

 Having dissected the ligaments (anterior and posterior), the joint is to be 

 opened and the synovial membrane examined. The bony articular surfaces 

 are also to be inspected, and the movements of which the joint is capable are to 

 be studied. The interosseous membrane is next to be dissected. The large 

 deficiency left at its upper part for the passage of the anterior tibial vessels 

 and. lymphatics is to be noted, and the anterior tibial lymphatic gland, if not 

 previously dissected, is now to be shown. In the lower part of the interosseous 

 membrane a small opening is to be displayed for the passage of the anterior 

 peroneal vessels. The inferior tibio-fibular joint is next to be examined, 

 pursuing the same order as in the examination of the superior. The ligaments 

 to be dissected are anterior, posterior, inferior interosseous, and transverse, 

 special attention being directed to the inferior interosseous ligament. The 

 joint having been opened, the synovial membrane (which is continuous with 

 that of the ankle-joint) is to be examined. Attention should next be directed 

 to the bony articular surfaces and the movements of which the joint is capable. 



The ankle-joint should now be carefully examined. The dissector should 

 first revise the muscular relations of the joint, and thereafter he should 

 dissect the following Ugaments : anterior, posterior, internal lateral or del- 

 toid, and external lateral in three fasciculi, anterior, middle, and posterior. 

 The anterior and posterior Ugaments are then to be cut and the synovial mem- 

 brane examined. Its continuity with the synovial membrane of the inferior 

 tibio-fibular joint is to be noted, and collections of fat covered by it (Haversian 

 glands) are to be shown at the front and back of the joint. The bony articular 

 surfaces are to be examined, and special attention is to be given to the move- 

 ments of which the joint is capable, and the muscles by which these are effected. 



The longitudinal and transverse arches of the foot should now receive careful 

 attention, and a review of the different varieties of club-foot and the tendons 

 involved will prove advantageous. Thereafter the articulations of the foot 

 are to be dissected, and in doing so it is advisable that the dissector should 

 have before him an articulated foot and the individual bones, all belonging 

 to the same side as that which he is dissecting. The tarsal articulations are 

 to be studied first, in the following order: (i) astragalo - calcaneal ; (2) 

 astragalo-navicular ; (3) calcaneo-cuboid ; (4) naviculo-cuboid ; (5) naviculo- 

 cuneiform ; (6) intercuneiform ; and (7) cubo-cuneiform. Before pursuing 

 this order the dissector should make himself familiar with the transverse 

 tarsal articulation — that is to say, the conjoined astragalo-navicular and 

 calcaneo-cuboid joints, where disarticulation is performed in Chopart's 

 operation. He should also study the expansions from the tendon of insertion 

 of the tibialis posticus, and he should at this stage revise the tendon of the 

 peroneus longus as it crosses the sole of the foot. In connection with the 

 astragalo-calcaneal articulation two joints are to be recognised — posterior 

 and anterior. The following ligaments are to be studied in connection with 

 the posterior joint : interosseous, posterior, internal, and external. Only 

 a lateral view of the interosseous ligament will be obtained at this stage, 

 as it lies in the sinus pedis. It is to be noted that this joint has a synovial 

 membrane peculiar to it. The anterior astragalo-calcaneal joint is next to 



