THE CUNEAN TENDON AND ITS BURSA 151 



THE CUNEAN TENDON AND ITS BURSA— CUNEAN 

 TENOTOMY 



The cunean tendon is one of the branches of the tendon of the deep 

 or muscular division of the flexor metatarsi. This branch may be 

 said to commence immediately the tendon of the deep division of the 

 muscle makes its appearance through the ring which is formed for its 

 passage by the tendon of the superficial portion of the muscle. The course 

 taken by the tendon is obliquely downwards and inwards across the front 

 of the scaphoid and the antero-internal corner of the cuneiform magnum, 

 to become inserted into the cuneiform parvum. 



As it passes over the bones it becomes very much flattened, and 

 its play over the scaphoid is facilitated by the presence of a small bursa. 

 Occasionally this sac becomes inflamed as a result of an injury received 

 over the antero-internal aspect of the joint. The bursa enlarges, and 

 two small fluctuating swellings make their appearance, one on either 

 edge of the cunean tendon. The ordinary treatment of acute bursitis 

 elsewhere should be adopted. 



It will be observed from our description of the cunean tendon above 

 that it passes over the common seat of spavin, and consequently attention 

 has been directed to the tendon and its bursa in the treatment of this 

 very troublesome affection. Abildgaard and Lafosse were the first to 

 practise section of the tendon in the treatment of spavin, the operation 

 being based on the opinion that lameness in spavin was due to pressure 

 of the tendon on the diseased area. The method of operation was to 

 make a cutaneous incision across the course of the tendon, and then sever 

 the latter. 



During recent years this operation has been commonly practised in 

 this country. Since 1900 it has been frequently performed by the writer, 

 who has found the method described as follows to be the best. The 

 patient should be cast on the side of the affected limb, and placed under 



