394 Anatomy Applied to Medicine and Suvge*y. 



pulp. A dorsal incision joining the ends of the former is 

 made, while the toe is forcibly flexed. In disarticulation 

 of the phalanges, it must not be forgotten that the joint 

 between the first and second phalanges corresponds to the 

 middle of the whole length of the toe, while the metatarso- 

 phalangeal articulation is about one inch behind the web 

 of the toe. In disarticulation of the first and second 

 phalanges of the toes, the usual incision is the oval or rac- 

 ket incision, and, in the case of the second phalanx, is 

 made by entering the knife about two-fifths of an inch 

 above the joint, while in the case of the first phalanx, the 

 incision begins a little below the joint. Continue the in- 

 cision, then, in the median line, along to the web of the 

 toe in the case of the first phalanx, or to the middle of the 

 phalanx in the case of the second one, and curve it down 

 to the plantar margins and join the ends by means of a 

 transverse incision. In the case of the first phalanx of the 

 great toe, this incision is modified by placing it at the junc- 

 tion of the internal and dorsal surfaces instead of in the 

 median line, so that, when disarticulated, the line of 

 union will be away from the line of pressure. Lis franc's 

 operation, or disarticulation at the tarso-metatarsal joint, 

 is done by an incision on the dorsum, starting about half 

 an inch behind the tuberosity of the fifth metatarsal bone, 

 and continued forwards iabout half an inch in front of 

 this tuberosity. It then passes across the dorsum of the 

 foot about half an inch in front of the line of the joints, 

 and then, on arriving at the inner border, it is turned back- 

 wards, along that border of the foot to end a little over 

 half an inch behind the joint line. The plantar incision 

 is made by entering the knife on the outer side of the foot, 

 in the original incision, and then, following the edge of 

 the fifth metatarsal bone for a short distance, it passes 

 obliquely to the neck of the fourth metatarsal from which 



