THE SOLE OF THE FOOT. 281 



the articulation is opened, and the lateral ligaments di- 

 vided, the posterior part of the capsule cut through, and 

 the os calcis sawn through obliquely from behind for- 

 wards and downwards. The anterior flap is dissected 

 off the malleoli, which are next sawn off, and the cut 

 surfaces approximated, and the tendo-Achillis, per- 

 haps, divided. (Pirogoff.) Syme's amputation consists 

 in removing the os calcis, and sawing off the ends of the 

 malleoli. In both these operations care must be taken 

 not to wound the trunk of the posterior tibial artery, 

 and to keep the external and internal plantar vessels as 

 long as possible. 



Club-foot (Talipes). The various deformities of the 

 foot, occurring at the tibio-tarsal or medio-tarsal articu- 

 lations, which are within the operative interference known 

 as tenotomy, are talipes equinus, in which the heel is 

 raised so that the individual walks on the ball of the 

 foot, in which case the tendo-Achillis requires division ; 

 talipes varus, or more precisely talipes equino-varus, 

 where the heel is raised, the foot turned inwards for 

 about the anterior two-thirds this inversion taking 

 place at the astragalo-scaphoid and calcaneo-cuboid ar- 

 ticulations, its dorsal aspect outwards, and the inner 

 edge drawn up ; the tendons requiring division being, 

 the tendo-Achillis, and the tendons of the tibialis posti- 

 cus, anticus, and flexor longus digitorum ; talipes valgus, 

 where the inner ankle is towards the ground and the 

 outer edge of the foot turned up ; the tendons to be di- 

 vided are, the peronei, and the extensor longus digi- 

 torum, and the plantar fascia ; talipes calcaneus, where 

 the patient walks on the heel, a case requiring division 

 of the tendons of the tibialis anticus, extensor communis 

 digitorum, extensor proprius pollicis, and peroneus ter- 



