282 SURGICAL ANATOMY OF 



tius. There are several intermediate forms; this is owing 

 to the fact that the posterior tibial nerve supplies the 

 gastrocnemius and soleus, which terminate in the tendo- 

 Achillis, and the tibialis posticus. Again, talipes equinus 

 and varus are usually associated, because the extensor 

 and peronei muscles are supplied by the anterior tibial 

 and musculo-cutaneous nerve. Talipes calcaneus and 

 valgus are generally associated. 



The tibialis posticus tendon is divided in tenotomy, 

 either above or below the ankle. The point selected 

 above the ankle is on the posterior margin of the tibia 

 about an inch or so above the malleolus, where it lies in 

 the groove in its own sheath and in contact with the 

 bone ; eversion of the foot tenses the tendon below the 

 ankle, at its insertion into the scaphoid. The point is 

 just above the astragalo-scaphoid articulation, which is 

 immediately behind the first tuberosity met with in pass- 

 ing the finger along the inner side of the foot, starting 

 at the malleolus. The tibialis anticus not being so con- 

 fined as the preceding can be more readily put on the 

 stretch, as it passes over the lower end of the tibia in the 

 innermost compartment of the annular ligament. It may 

 be also divided at its insertion into the inner cuneiform 

 bone, the position of which attachment may be ascer- 

 tained by passing the finger along the inner surface of 

 the foot, when it is just in front of the articulation of the 

 scaphoid with the inner cuneiform. 



In performing the tarso-metatarsal disarticulation, 

 known as Hey's or Lisfranc's, the line of the joint may 

 be exposed, in the first place, by starting from the outer 

 surface of the foot from a point immediately behind the 

 tuberosity of the fifth metatarsal bone to a point which 

 may be indicated in one of the following ways : (1) If 



