. The principles and practice of surgery. he articula-tions are, therefore, not so short and compact as those of the tarso-metatarsal articulation, and the joint may be easily entered with aknife from almost any point except perhaps the plantar surface. Theprincipal difficulty which the surgeon experiences is in finding a reliableguide to the articulation. The measurements made from the malleoli,and from other points, vary so much in different subjects as to be whollyuntrustworthy. The only guide which under nearly all circumstancescan be relied upon is the inner side of the scaphoid bone. Thi
. The principles and practice of surgery. he articula-tions are, therefore, not so short and compact as those of the tarso-metatarsal articulation, and the joint may be easily entered with aknife from almost any point except perhaps the plantar surface. Theprincipal difficulty which the surgeon experiences is in finding a reliableguide to the articulation. The measurements made from the malleoli,and from other points, vary so much in different subjects as to be whollyuntrustworthy. The only guide which under nearly all circumstancescan be relied upon is the inner side of the scaphoid bone. This formsthe only remarkable prominence on the inside of the foot below the AMPUTATION OF THE FOOT. 363 ankle, and cannot be confounded with anything else, especially if weplace the finger on this prominence and then alternately adduct andabduct the foot. We shall then observe that the only point of mo-tion during this manipulation is just above this prominence ; thatis, between the scaphoid and the head of the astragalus. I have Fig. Plantar Flap in Medio-tarsal Amputation. never found a subject so fat, or a limb so infiltrated with inflam-matory effusions that the point of motion could not be distinctlydefined, and that a knife could not be entered with certainty into thejoint. There are no ligaments on the inside of the foot between the astrag-alus and the scaphoid, and but one thin feeble ligament above, namely,the superior astragalo scaphoid. Standing erect, the weight of the body falls to the inner side ofthe centre of the arch of the foot, consequently the foot is inclinedto be pressed or splayed outwards, and this would be its constantposition, were it not for the powerful muscles whose tendons passbehind the malleolus internus, and for certain strong ligaments. Theseligaments—for the muscles do not interest us in this connection—are thedeep and superficial layers of the internal lateral or deltoid, belongingto the ankle-joint. The deep layer passes from the ape
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Keywords: ., bookcentury1800, bookdecade1870, booksubjectg, booksubjectsurgery
