thp: foot 



HDD 



spending to the calcaneo-cuboid joint, just midway between the tiji of tin- t-xternal 

 malleolus and the haso of the fifth metatarsal I)()n"e. 



In Lisfranc's, (ir Key's, or tlie tarso-metatarsal amputation, the Imses of 

 the fifth and first metatarsals must he defined. Tlie first of tliese ean always he 

 detected, even in a stout or swollen foot; on the inner side the joint between the 

 internal cuneiform and the first metatarsal bone lies an inch and a half in front of 

 the sca])hoid tubercle. In oj)eninf; the joint l)etween the second metatarsal and 

 the middle cuneiform, its position (the base of the former bone projecting upwards 

 on to a level one-third or one-fourth of an inch aljove the others), and the way 

 in which it is locked in between its fellows and the cuneiform bones, must l)e 

 remembered. 



In marking out the flaps for the amputation of the great toe, the large size 

 of the head of the first metatarsal, and the im})urtance of leaving tliis so as not to 

 diminish its supporting power and the treading Avidth of the foot, and thus of 

 marking out flaps suthciently long and large, must be l)orne in mind. In amputa- 

 tion of the other toes, the line of their metatarso-i)halangeal joints lies a full inch 

 above the web. 



Bursae and synovial membranes. — The synovial sheath of the extensor 



Fig. 763.— Vertical Section THROUon the Ci-neiform and Cuboid Bones. (One-half.) 



Dorsiilis peili.s vessuls and SERVE 

 Extensor proprius hallucia 



INTERNAL CUNEIFORM | MIDDLE CUNEIFORM 



Tibialis amicus 



EXTERNAL CUNEIFORM 



Extensor brevis digitorum 

 Dorsal aponeurosis 



Peroneus tertius 



Abductor hallucis 

 Internal plantar ivj.v.sr/* mid SEE VE 

 Abductor hallucis 



Flexor longus halluots 



Plantar fascia 

 Flexor longus digitorum 



Flexor brevis digitoruin 



Abductor minimi digiti 



Erlerniit jdnntar ressels and SEE VE 

 Tendon of peroneus longus 



proprius hallucis extends from the front of the ankle, over the inste]). as far as the 

 metatarsal bone of the great toe. There is generally a bursa over the in-^teji. above, 

 or it may be below, the tendon. There is often an irregular Imrsa between the 

 tendons of the extensor longus digitorum and the jirojecting end of the astragalus 

 over which the tendons play. There is much friction here. It is well to l)e 

 aware that this bursa sometimes communicates with the joint of the head of the 

 astragalus ('Holden). There is a deep synovial bursa between the tendo Achillis 

 and the calcaneum. Numerous other bursa? may appear over any of the bony 

 l)oints in the foot, especially when they are rendered over-prominent by morbid 

 conditions. 



Synovial membranes. — In addition to that of the ankle-joint, there are six 

 synovial iiienil)ranes in the tarsus, viz.: — (1) Posterior calcaneo-astragaloi<K 

 peculiar to these bones; (2) anterior calcaneo-astragaloid, common to these bones 

 and the scaphoid; (3) between the calcaneum and the cuV)oid; (4) between the 

 cuboid and the outer two metatarsals; (5) between the internal cuneiform and the 

 first metatarsal; (6) a complicated and extensive one. which l)ranches out between 

 the scaphoid and cuneiform ])ones; between the cuneiforms; between the external 

 cuneiform and the cuboid; between the middle and outer cuneiform and the second 



