REGIONS OF THE FOOT. 



853 



least, if not positive, in the examination of 

 an injury to some of the larger vessels, as the 

 femoral or the anterior tibial. For though, 

 owing to occasional varieties in the course and 

 distribution of the dorsal arteries of the foot, 

 the absence of pulsation in the situation of 

 the arteria dorsalis pedis, just indicated, would 

 not be a positive proof of injury to the larger 

 vessels, (though even this might be received 

 as valuable corroborative evidence,) yet the 

 clear and full pulsation of this vessel would 

 of course be undoubted evidence that the 

 larger arteries were safe and sound. (See 

 TIBIAL ARTERIES.) 



II. Region of the toes. In the natural state 

 the toes are covered by a skin, soft and pliable, 

 except the extreme phalanx, the dorsal surface 

 of which is defended by the nail, for the struc- 

 ture and arrangement of which we refer to 

 the article TEGUMENTARY SYSTEM. Under 

 the skin and subcutaneous tissue we find the 

 tendon of the long extensor, lying close upon 

 the bone adhering to it and to the synovial 

 membranes of the joints, by short but free 

 cellular tissue, sufficiently loose to allow of 

 the free movements of the subjacent joints. 

 We observe that the length of the toes, by 

 the construction of the bones, much shorter 

 and smaller than the fingers, appears shorter 

 still in the metatarsal phalanx by the greater 

 depth of the integu mental web between the 

 toes. The operator will do well to remember 

 this in amputating at the metatarso-phalangeal 

 joint, or he will surely be foiled in his attempt 

 to open it, particularly as this joint, lying 

 deeper and being composed of smaller bones 

 than the corresponding joint of the hand, is 

 much less readily perceptible, even to the 

 touch. Lastly, these organs, the toes, more 

 universally, and in greater degree perhaps than 

 any other part of the body, pay the penalty 

 of hyper-refinement and civilization in the 

 distortion and disfigurement of their entire 

 structure from pressure. The skin suffers most 

 acutely; it becomes entirely altered in struc- 

 ture. The soft cuticle which covered it is, 

 by the irritation of pressure, increased in thick- 

 ness by successive additional layers. This 

 increase is greatest just at the point where 

 there is most pressure, namely, at the upper 

 and lateral parts of the projecting joints ; 

 nature thus providing a defence for the tender 

 cutis, pressed between the bone and the shoe. 

 The cause of irritation being still continued, 

 the defence itself is converted into an ad- 

 ditional enemy ; the accumulated layers of 

 hardened cuticle form a hard corn, and irritate 

 and inflame the subjacent cutis. Another 

 effort of nature is made to relieve the suffering 

 parts ; a small bursa is formed under the 

 most prominent part of the corn, and this 

 again is made an additional cause of suffering 

 by this part also becoming inflamed, the original 

 source of evil not being removed. The same 

 process taking place between the toes by the 

 pressure of one toe against the other, produces 

 the soft corn by the moisture of this part not 

 allowing the thickened cuticle to become hard 

 and dry. The same process on a larger scale 



VOL. ir. 



over the joints of the great toe occasions the 

 bunion,* the bursal cysts of which form a 

 beautiful illustration of the powers of nature 

 in accommodating herself to accidental circum- 

 stances. 



Nor is the mischief arising from this oppo- 

 sition to nature confined to the results now 

 mentioned. The toes, from being constantly 

 kept in a distorted position, acquire perma- 

 nently an unnatural form, sometimes being 

 bent laterally under or over each other, the 

 ligaments become stretched, the articular car- 

 tilages absorbed, the ends of the bones altered 

 in form, and anchylosis is not unfrequently 

 the result. If the shoe be too short, a per- 

 manent contraction of the joint of the toe is 

 produced, which is sometimes so distressing 

 in walking as to be a serious impediment to 

 this exercise, and even to demand amputation 

 of the toe as the only means of deliverance. 

 This, when it does occur, is almost always 

 found in the second toe, because it projects 

 beyond the others. 



Plantar region. The plantar region, like 

 the dorsal, may be divided into the plantar 

 region, strictly so called, and the region of 

 the toes. 



I. Proper plantar region. The skin upon 

 the sole of the foot is covered by a cuticle 

 remarkable both for its general density and for 

 the great difference of its density in different 

 parts. In the hollow of the sole it is thinnest, 

 next along the outer side, and thickest of all 

 under the heel and heads of the metatarsal 

 bones. This great thickness of the cuticle, 

 though partly arising from pressure, is yet 

 partly natural, being found in some degree 

 even in the foetus, and is one of those marks 

 of Provident Wisdom of which every part of 

 our structure furnishes instances. The cutis 

 itself is still more striking for the strength and 

 density of its structure, which we observe 

 particularly in dissecting this part. The scal- 

 pel must be sharp indeed to cut through it 

 with ease. This, in fact, with its horny 

 cuticle is nature's provision against the injuries 

 to which the important parts of the sole are 

 exposed, and the only defence, the only sandal 

 worn to this day by multitudes. Its structure, 

 as shewn by removing carefully the cellular 

 tissue from its inner surface, is composed of a 

 number of whitish glistening fibres crossing 

 each other in every direction, and enclosing 

 in their meshes portions of that granular fat 

 which forms the layer immediately subjacent 

 to the skin. These meshes are closer and 

 smaller as we approach the outer surface, 

 where the cells entirely disappear. When the 

 cuticle is separated from it, the cutis exhibits 

 a vast number of exhalent pores, the source of 

 that profuse perspiration which is given off 

 from this part of the feet under exercise ; these 

 are pretty equally distributed over the sole, but 

 the great thickness of the epidermis at the 

 heel must impede the transpiration through it 



* See an excellent paper by Mr. Key in Guy's 

 Hospital Reports. Vide Clinical Lecture on Corns 

 and Bunions, by Sir B. C. Brodie, Bart, in the 

 Med. Gazette, vol. xvii. 



