. Text-book of operative surgery . alcis and astragalus posteri-orly and the cuboid and scaphoidanteriorly. The Operation offenresults in a bad stump from thefoot assuming the equinus position,and pressure occurring at theanterior and lower part of the oscalcis. This is easily understoodsince all the tendons on the dorsumof the foot have been divided,while the powerful tendo Achillisis left intact. It is necessary,therefore, to elongate the tendoAchillis, so that the stump maybe retained at right augies to theleg until the extensors have gaineda firm attachment to the deeperpart of the cicatri
. Text-book of operative surgery . alcis and astragalus posteri-orly and the cuboid and scaphoidanteriorly. The Operation offenresults in a bad stump from thefoot assuming the equinus position,and pressure occurring at theanterior and lower part of the oscalcis. This is easily understoodsince all the tendons on the dorsumof the foot have been divided,while the powerful tendo Achillisis left intact. It is necessary,therefore, to elongate the tendoAchillis, so that the stump maybe retained at right augies to theleg until the extensors have gaineda firm attachment to the deeperpart of the cicatrix. Instead of vvaiting for this, the ends of the tendons may be sutured at once to the periosteumand ligaments on the dorsum with the foot at right angles. Internally the Joint line lies behind the projecting tubercle of the scaphoid,externally in front of the ridge on the greater process of the os calcis. The Operationis performed by making two rounded flaps, the dorsal extending a thumbs-breadth infront of the line of the Fig. 214.—Posterior intertarsal disarticulation by aplantar Aap and convex dorsal incision. The skinon the dorsum is retracted ; tlie tendons are dividedand the Joint is opeued, exposing posteriorly thearticular surface of the head of the astragalus andthe os calcis. Anteriorly are seeu the articularsurface of the scaphoid and part of the cuboid. 346 OPERATIVE SURGERY The dorsal tendons are cut with the foot at right angles. Tlie dorsal incision iscarried down to the hone across the sca^^hoid and cuboid, the Joint capsule heing thenstripped back for a distance of 1 cm. The Joint between the head of the astragalusand the scaphoid, which is convex downwards, is then opened from above. Towardsthe outer border of the foot the knife must be directed towards the toes, for the outerpart of the calcaneo-cuboid Joint is concave anteriorly, the line of the Joint is^^J shaped. If the knife be carried too far back, it will open the astragalo-calcaneanJoin
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