488 The Leg 



which is fast2:ied above the knee. In certain cases of paralytic talipes 

 calcaneus a piece is cut out of the tendon, and the ends are spliced 

 together. 



The flexor long-us hailucis is a large and very powerful muscle 

 arising from the lower two-thirds of the back of the fibula. Its tendon 

 passes over the tibia, to the outer side of the posterior tibial vessels 

 and nerve, and behind the ankle-joint ; it then grooves the back of the 

 astragalus, anc 1 , passing under the sustentaculum tali, runs between 

 the two heads of the flexor brevis hailucis to be inserted into the 

 lingual phalanx. To the outer side of the muscle are the fibula and 

 the soleus, to the inner side are the long flexor of the toes, the tibialis 

 posticus, and the posterior tibial vessels and nerve ; in its substance is 

 the peroneal artery. In the sole the tendon is united with that of the 

 flexor longus digitorum by a strong slip. 



The flexor longus digitorum arises from the tibia below the 

 soleus. Its tendon lies in the groove behind the inner malleolus, with 

 that of the tibialis posticus, but in a separate synovia! sheath ; 

 and, passing through the sole, where it receives a slip from the tendon 

 of the long flexor of the great toe, it divides into four tendons which 

 are inserted into the ungual phalanges of the four outer toes. These 

 tendons perforate those of the flexor brevis digitorum. The posterior 

 tibial vessels and nerves rest upon the long flexor. 



Tenotomy of the flexor longus is sometimes required in extreme 

 talpes equino-varus ; the tendon is then divided, together with that of 

 the tibialis posticus, by a wound made a little above the inner malleolus, 

 or, preferably, by an open incision nearer the sole of the foot. In the 

 former case, should the posterior tibial artery be accidentally punctured 

 or divided, the bleeding may be arrested by bandaging a firm pad over 

 the inner ankle, so as to compress the artery against the posterior 

 surface of the tibia. It is rarely necessary to enlarge the wound and 

 tie the vessel. 



The tibialis i ostictn arises from the bick of the interosseous 

 membrane and from the adjacent surfaces of the tibia and fibula. The 

 tendon passes inwards on the tibial aspect of that of the flexor longus 

 digitorum, and rather to its inner side, and, running with that tendon 

 beneath the head of the astragalus, is inserted into the scaphoid and 

 internal cuneiform bones. It also sends back a slip to the sustentaculum 

 tali, and other slips to the outer cuneiform bones, the cuboid, and tin- 

 bases of the middle metatarsal bones. Thus it is an important struct ire 

 in supporting the transverse as well as the antero-posterior arch of the foo' . 



The muscle is covered by the flexor longus digitorum on the inner, 

 and by the flexor longus hailucis on the outer side ; on it rest the 

 beginnings of the posterior tibial and the peroneal arteries, and the 

 posterior tibial nerve. At the ankle its tendon is the innermost, lying 

 in the same groove with that of the flexor longus digitorum, but in a. 

 separate synovial sheath. 



