356 



REGIONS OF THE FOOT. 



tendons in them, or, going still further, com- 

 municates the inflammation to the tendon, 

 and occasions it to slough. Moreover, the 

 tendinous structure which envelopes some of 

 these bursal cavities is the cause of those 

 violent and alarming symptoms of constitu- 

 tional irritation, by no means uncommon when 

 only a very small quantity of matter has formed 

 within them, a state sometimes almost instan- 

 taneously relieved by a judicious opening made 

 with the lancet, and giving exit to even so small 

 a quantity of pus. 3d, Why severe contusions 

 or lacerations are here so often followed by bad 

 consequences, the power of repair in tendinous 

 structures, which so largely enter into the 

 composition of the parts about the foot, being 

 small, and consequently the inflammation fre- 

 quently proving the destruction either of the 

 structure or the functions of the parts affected. 

 The study of the nature and position of these 

 joints of the foot is of great interest and im- 

 portance to the surgeon, and it will not be in- 

 appropriate in this article to offer some obser- 

 vations upon some of the operations in which 

 they are concerned. Modern surgery, whose 

 greatest triumphs have been in the saving of 

 limbs, not in removing them, in discovering the 

 least possible quantity of loss by which the 

 disease might be eradicated, rather than the 

 readiest method of taking off the entire limb, 

 has taught us not to be deterred by the intrica- 

 cies of the numerous joints of the foot, but 

 fearlessly to lead the knife through any part of 

 them, so that we may only save a serviceable 

 portion, which may be more convenient than a 

 wooden substitute. The removal of the toes at 

 their joints is comparatively easy, though it 

 should be remembered, in amputating at the 

 metatarso-phalangeal joint, that this articulation 

 is situated much deeper than the corresponding 

 one of the hand, owing to the greater length of 

 the web and greater thickness of the member 

 itself. The metatarsal bones may be removed 

 separately or altogether from their junction with 

 the tarsus, as first done by Iley of Leeds, and 

 described in his Surgical Observations. The 

 removal of a single bone is, except it be either 

 the first or the fifth, more difficult and even 

 more dangerous, in regard to the liability to 

 after inflammation, than the removal of the 

 whole metatarsus. In performing this last 

 operation, the guide for entering the whole row 

 of joints is the projecting tubercle of the fifth 

 metatarsal bone, immediately behind which the 

 joint may be opened, and on coming to the 

 projection of the inner cuneiform bone, (see 

 Jig. 1 67,) most surgeons recommend the cutting 



Fig. 167. 



extracted, both with and without the attached 

 metatarsal bones. Of the former kind a very 

 remarkable instance is given by Mr. Key in the 

 second number of Guy's Hospital Reports, in 

 which the only bones of the tarsus left were the 

 os calcis, astragalus, scaphoid, and internal 

 cuneiform bones as a support to the great toe. 

 (See Jigs. 167 and 168, in the first of which the 

 dotted line represents the portion of the bones 

 of the foot which was removed in Jig. 168.) 



Fig. 168. 



off its projecting part, rather than to finish by 

 opening the joint. The tarsal bones have been 



Should disease or accident have destroyed 

 all, or most of the bones in the front row of the 

 tarsus, they may all be readily removed by 

 amputation at the astragalo-scaphoid and calca- 

 neo-cuboid joints, an operation generally known 

 as that of Chopart, who first practised it. How 

 far, however, such a portion of the foot pre- 

 served is preferable to the use of a short wooden 

 leg applied to the end of the limb, amputated 

 a little above the ankle, (a plan which we have 

 used with perfect success,) certainly admits of 

 a doubt. At any rate its advantages cannot be 

 put in competition with the principle so admi- 

 rably illustrated by Mr. Key in the before 

 mentioned case, of saving, if possible, a portion 

 of the metatarsus and toes, though at the risk 

 of a more painful, and perhaps more dangerous 

 operation. 



Upon a general survey of the structure and 

 form of the foot, we are struck with the differ- 

 ence between this organ in man and in all other 

 animals. The most striking peculiarities con- 

 sist in the great breadth of the foot, its short- 

 ness in proportion to the leg, the large size of 

 the bones of the tarsus, the relative shortness 

 and smallness of the four outer toes, and the 

 great size of the inner one, the great strength 

 of the calcaneum, and lastly, in those arches 

 produced by the arrangement and form of the 

 tarsal and metatarsal bones. The only animal 

 that nearly approaches to the form of man, 

 the monkey, yet differs from him in all these 

 points. Its foot is narrower and longer in 

 proportion to the leg, its tarsal bones are 

 smaller, its four outer toes are long like the 

 fingers, while the first is small, and separated 

 from the rest. The calcaneum is relatively 

 small, arid inclines upwards at its posterior 

 projection, while the peculiarities already spe- 

 cified necessarily occasion that the arches of 

 the foot are much less distinct than in man. 

 Indeed, in supporting itself erect, the monkey 

 rests very much on the outer side of the foot, 

 probably on this account. In all other animals 

 these differences are still more marked. What 



