1198 



SURGICAL AND TOPOGRAPHICAL ANATOMY 



tendons. Division below the external malleolus is somewhat easier, but as this 

 opens their synovial sheath or sheaths {vide supra, page 1197), it requires scrupu- 

 lous care as to cleanliness. 



THE FOOT 



Bony landmarks. — The following are of the greatest practical importance 

 owing to the operations which are jjerformed upon the foot. 



(A) Along the inner aspect of the foot are the following: — 



(1) Internal tuberosity of the calcaneum; (2) internal malleolus; (3) one full 

 inch below the malleolus, the sustentaculum tali; (4) about an inch in front of 

 the internal malleolus, and a little lower, is the tubercle of the scaphoid, the gap 

 between it and the sustentaculum ])eing filled by the calcaneo-scaphoid ligament 

 and the tendon of the tibialis posticus, in which there is often a sesamoid Ixnie; 

 (5) the internal cuneiform; (6) the base of the first metatarsal; and (7) the head 

 of the same bone, with its vSesamoid bones below (Holdenj. 



(B) Along the outer aspect are — (1) The outer tuberosity of the calcaneum; 



Fig. 762. — Articulations of the Foot, Dorsal Aspect. (Bellamy.) 



TUBERCLE OF SCAPHOID 



l;ne of hey -' 



LINE OF CHOPART 



TUBERCLE OF FIFTH METATARSAL 



(2) the external malleolus; (3) the peroneal tubercle of the calcaneum (when 

 present), one inch below the malleolus, with the long peroneal tendon below it, and 

 the short one above; (4) the projection of the anterior end of the calcaneum, 

 and the calcaneo-cuboid joint, midwa}^ between the tip of the external malleolus 

 and the base of the fifth metatarsal bone; (5) the base of the fifth metatarsal bone; 

 (6) the head of this bone. 



Levels of joints and lines of operations. — In Syme's amputation through 

 the ankle-joint, the incision starts (say in the case of the left foot) from the tip of 

 the external malleolus, and is then carried, pointing a little ])ackwards towards the 

 heel, across the sole to a point half an inch below the internal malleolus. 



In Pirogoff's amputation the incision begins and ends at the same points, but 

 is carried straight across the sole. In each am})Utation the extremities of the above 

 incision are joined by one going straight across the ankle-joint, which lies about 

 half an inch above the tip of the internal malleolus. 



In Chopart's medio-tarsal amputation (fig. 762), which passes between the 

 astragalus and the sca})hoi(l on the inner side, and the calcaneum and the cuboid 

 on the outer, the line of the joints to be opened would be one drawn across the 

 dorsum from a point just behind the tuberosity of the scajthoid to a i)oint corre- 



