WOUNDS 223 



antiseptic solution, the patient cast and chloroformed, and 

 the operation proceeded with. 



An Esmarch's bandage should be first applied, and a 

 tourniquet afterwards placed higher up on the limb. The 

 foot is then secured as described in an earlier chapter, and 

 the whole of the horny structure of the lower surface of 

 the foot (the sole, the frog, and the bars) pared until quite 

 near the sensitive structure, or, if under-run with pus, 

 stripped off entirely. An incision is then made in each 

 lateral lacuna of the frog, the two meeting at the frog's 

 point. Each incision thus made should be carried deep 

 enough to cut through the substance of the plantar cushion. 

 A tape is then passed through the point of the frog, tied in 

 a loop, and given to an assistant to draw backwards. The 

 plantar cushion itself is then incised in a direction from 



Fig. 106— 'Curette,' or Volkmann's Spoon. 



before backwards, and pulled on by the assistant, so as to 

 expose the plantar aponeurosis. 



Should this be found at all necrotic, it may be taken that 

 purulent inflammation of the navicular bursa and of the 

 navicular bone itself exists. The operator must then pro- 

 ceed to resection of the tendon in order to treat the deeper 

 structures thus affected. At its point of insertion into the 

 semilunar crest the tendon is severed and afterwards re- 

 flected. This exposes the inferior face of the navicular 

 bone. Instead of the glistening and clear appearance it 

 ordinarily presents, its glenoid cartilage is found to be 

 showing hemorrhagic or even purulent spots of necrosis. 

 The terminal portion of the tendon must then be excised. 



To effect this a clean transverse incision is made at the 

 extreme upper border of the navicular bone. Here we are 

 in close contact with the pedal articulation, and great care 



