494 Anterior Tibial Artery 



ligament. The tibialis anticus tendon is well ti the inner side, and 

 that of the special extensor of the great toe, running along the artery 

 from its outer side, must be drawn outwards. The nerve is most 

 likely to the outer side, and from that side, therefore, the needle 

 should be passed, the artery having been isolated from its companion 

 veins. The great point in this operation is to keep close on the outer 

 side of th 2 tendon of the tibialis anticus, which is itself close to the 

 tibial crest. 



The C'Hater >l circulation after ligation of the anterior tibial 

 wjuld b2 c irried on through muscular and periosteal branches ; by 

 inosculations of its empty branches with branches of the anterior pero- 

 neal and the posterior tibial arteries through the malleolar, tarsal, and 

 metatarsal branches ; and by the junction of the communicating branch 

 of thedorsalis pedis with the external plantar in the plantar arch. 



The extensor brevis digitorum appears as a firm elevation 

 through the thin skin on the outer side of the dorsum of the foot. It 

 arises from the front of the upper and outer part of the os calcis, and 

 from the anterior annular ligament. The innermost of its four ten- 

 dons is inserted independently into the base of the first phalanx of the 

 great toe, but the three other slips join with the three inner tendons 

 of the long extensor. Each of these conjoined tendons spreads out 

 and divides into three s'ips, of which the middle piece is inserted into 

 the base of the middle phalanx, whilst the lateral slips pass on to the 

 last phalanx. 



Relations.- The muscle is covered by a layer of deep "fascia, by 

 the peroneus tertius, and by the tendons of the extensor longus digi- 

 torum. It rests upon tarsal and metatarsal bones, the interosseous 

 muscles, and the outer, ganglionic, branch of the anterior tibial nerve, 

 which supplies the muscle as well as the tarsus. The dorsal artery 

 lies along its inner side, and the inner border of the muscle may just 

 overlap it. The innermost tendon crosses over the vessel in its 

 course to the first phalanx of the great toe. The innermost border of 

 the short extensor is the surgeon's guide to the artery. 



The dorsalls pedis artery continues the anterior tibial from the 

 middle of the front of the ankle in the line which passes thence to the 

 cleft between, and the great and second toes. But, let it be well noted, 

 the dorsal artery itself does not reach this cleft ; a couple of inches 

 behind this, at the root of the first interosseous space, it divides into 

 the dorsalis Jiallucis and the communicating. 



Relation*. The artery rests upon the astragalus, scaphoid, and 

 internal cuneiform, and their dorsal ligaments. It is covered by \\\v 

 integument, superficial and deep fascia-, and by the innermost slip of 

 the extensor brevis digitorum. On the inner side is the special ex- 

 tensor of the great toe, and on the outer side are the long and short 

 extensors of the toes, and the anterior tibial nerve. On cither side is 

 a companion vein. 



