5 1 o Bones of Foot 



dissected foot, a dot is made close behind the ridge on base of the first 

 metatarsal bone, and another behind the tuberosity of the fifth, and 

 these dots are provisionally connected by an oblique line. Then the 

 shaft of the second bone is traced back into its expanded base amongst 

 the cuneiforms, and there a squared, but a slightly oblique, notch is 

 depicted. The latter part of this plan has to be made by estimation, as 

 the mortise cannot be actually felt. It is about a quarter of an inch 

 deep. It is shown on p. 507. 



The tips of the index-finger and thumb are kept upon the inner 

 and outer landmarks of this tarso-metatarsal joint in Hey's and in 

 Xiistranc's operation. The latter amputation consists in disarticu- 

 lating all the metatarsal bones ; but in the amputation which bears 

 the name of the English surgeon the base of the second bone is 

 not disarticulated, but sawn across, or the internal cuneiform is 

 divided. 



In Hey's and Lisfranc's amputation a very short dorsal flap is 

 raised, as in Chopart's operation (p. 500), whilst the sole of the foot is 

 made to supply the covering for the naked surfaces of the cuboid and 

 cuneiforms. This flap should be cut longer on the inner side, as the 

 surface of the internal cuneiform which it has to cover is deeper than 

 that of the cuboid. Branches of the two plantar arteries will require 

 ligation ; but the main trunk of the external, which crosses the roots 

 of the metatarsal bones, may just escape the knife. 



Hallux valg-us. As a result of wearing boots with narrow toes, 



the great toe is thrust ' outwards, 

 until it may lie under or over the 

 neighbouring toes. The partial out- 

 ward dislocation of the base of the 

 first phalanx leaves the inner surface 

 of the head of the first metatarsal 

 bone prominent beneath the skin, 

 and unprotected from the pressure 

 of the boot. It is, however, the strain 

 upon the joint, not the pressure of 

 the boot, which sets up the trouble 

 and pain in the joint. The ap- 

 pearance presented by the great toe is something like knock-knee, 

 and is called hallux valgus. When the deformity is slight it may be 

 treated by wide-toed boots, and by wearing a pad of cotton-wool in the 

 first cleft. But, if it be severe, the shaft of the first metatarsal may 

 be divided, the distal part of the bone being so arranged that the 

 phalanges may lie in the direction of the inner border of the foot. 



Unless the case be duly treated, the mucous bursa which is apt to 

 be developed by friction on the inner side of the head of the meta- 

 tarsal bone becomes inflamed. The large round and painful swelling 

 then produced is called bunion (3ouwy, mound}. 



