. Text-book of operative surgery . agalus and the scaphoid, and lastly betweenthe astragalus and os calcis (Fig. 141). In tubercular Ostitis,which frequently begins in the bases of the metatarsal bones,excision of the bases and of the articular surfaces of theadjacent cuneiforms and cuboid is occasionally sufficient(tarso-metatarsal resection). When, however, the tarso-meta-tarsal joints are involved, it is safer to excise the scaphoidas well as the bones above mentioned. If the disease is stillmore diffuse the articular surfaces of the astragahis and oscalcis must also be removed. The excisio
. Text-book of operative surgery . agalus and the scaphoid, and lastly betweenthe astragalus and os calcis (Fig. 141). In tubercular Ostitis,which frequently begins in the bases of the metatarsal bones,excision of the bases and of the articular surfaces of theadjacent cuneiforms and cuboid is occasionally sufficient(tarso-metatarsal resection). When, however, the tarso-meta-tarsal joints are involved, it is safer to excise the scaphoidas well as the bones above mentioned. If the disease is stillmore diffuse the articular surfaces of the astragahis and oscalcis must also be removed. The excision is performed by means of two dorso-lateralincisions (Fig. 141). The internal incision extends from theposterior third of the first metatarsal backwards as far asthe inner aspect of the head of the astragalus, which isbrought into view by abducting the foot. The posteriorpart of the incision divides the skin only, so as to avoid openiug the part of theankle-joint which projects forwards on to the neck of the astragalus. Beginning. Fig. 1-il.—Excision 01 theaiiterinr tarsus (xisiial ar-rangenient of tlie sjiiovialcavities). 282 OPERATIVE SURGERY internal to the extensor tendons of the great toe, the incision divides the attach-ment of tlie tibialis anticus to the first metatarsal and internal cuneiform, andexposes the dorsal surfaces of the cuneiform and scaphoid bones. The under surfacesof those bones are now laid bare, the tendon of the tibialis posticus lying posteriorlyand inferiorly. The external incision, which is placed external to the extensor tendons, extendsfrom the posterior third of the fifth metatarsal to the upper surface of the os calcisin front of the external malleolus. The tendon of the peroneus tertius is separatedfrom its Insertion into the base of the fifth metatarsal, and the dorsal aspects of thecuboid and outer metatarsals are exposed. To lay bare the under surfaces of thesebones, the tendons of the peroneus brevis and longus must be separated and draw
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