382 Anatomy Applied to Medicine and Sutgery. 



ficial structures and running in front of the inner malleo- 

 lus, are the long saphenous vein and nerve, while more ex- 

 ternally are the branches of the musculo-cutaneous nerve. 

 On the outer side are, from before backwards: (1) The 

 peroneus brevis, and (2) the peroneus longus lying behind 

 the outer malleolus and contained in a common synovial 

 sheath; (3) external calcanean branches of the pero- 

 neal artery, while superficially, about midway between the 

 outer malleolus and the centre of the heel, are the external 

 saphenous nerve and vein. Internally are : (1) Thetibialis 

 posticus; (2) flexor longus digitorum; (3) posterior 

 tibial artery with its venae comites, one on either side ; (4) 

 posterior tibial nerve, and (5) flexor longus hallucis. The 

 space occupied behind the inner malleolus, by each of 

 these structures, is as follows : The tibialis posticus, one- 

 quarter of an inch; the flexor longus digitorum, one- 

 quarter of an inch ; the vessels and nerve, three-eighths of 

 an inch, and the flexor longus hallucis, including the mus- 

 cular fibres, which are attached low down to its tendon, 

 one-half inch. 



Tenotomy or division of tendons. Before the days 

 of aseptic surgery, the subcutaneous division of tendons 

 was a very important procedure for the correction of the 

 different varieties of club-foot, and certain situations were 

 selected at which to divide the tendons, so as to avoid their 

 synovial sheaths, and, since the surgeon may occasionally 

 be called upon to divide them, it is, therefore, advisable to 

 briefly refer to the operation. When tenotomy is required 

 in the treatment o>f club-foot, it may be performed on the 

 individual tendons at the following .points : (1) The tib- 

 ialis anticus tendon may be divided as it crosses the 

 scaphoid bone, i.e., about one inch above its insertion, 

 since the synovial sheath for the tendon ends just above 

 this point. This is one of the tendons that need to be 



