Human anatomy; Medicine -- Study and teaching; Palpation
In a young and fat child, where the inner edge of the tibia cannot be
distinctly felt, the best guide to the tendon is a point midway between
the front and the back of the ankle. An incision in front of this
point might injure the internal saphena vein; behind this point, the
posterior tibial artery.
119. =Tendons behind outer ankle.=--Behind the malleolus externus we
feel the two peroneal (long and short) tendons. They lie close to the
edge of the fibula, the short one nearer to the bone. In dividing these
tendons, the knife should be introduced perpendicularly to the surface,
and about two inches above the apex of the ankle, so as to be above the
synovial sheaths of the tendons.
=Tendons in front of ankle.=--Over the front of the ankle, when
the muscles are in action, we can see and feel, beginning on the
inner side, the tendons of the tibialis anticus, the extensor longus
pollicis, the extensor longus digitorum, and the peroneus tertius. They
start up like cords when the foot is raised, and are kept in their
proper relative position by strong pulleys formed by the anterior
annular ligament. Of these pulleys the strongest is that of the
extensor communis digitorum. When the ankle is sprained, the pain and
swelling arise from a stretching of these pulleys and effusion into
their synovial sheaths. A laceration of one of the pulleys and escape
of the tendon is extremely rare.
The place for the division of the tendon of the tibialis anticus, so as
to divide it below its synovial sheath, is about one inch before its
insertion into the cuneiform bone. The knife should be introduced on
the outer side, so as to avoid the dorsal artery of the foot.
Now trace the lines of the arteries, and the landmarks near which they
divide.
120. =Popliteal artery.=--About one inch and a quarter below the head
of the fibula, or say one inch below the tubercle of the tibia, the
popliteal artery divides into the anterior and posterior tibial. The
peroneal comes off from the posterior tibial about three inches below
the head of the fibula.
Consequently we may lay down, as a general rule, that, in amputations
one inch below the head of the fibula, only one main artery, the
popliteal, is divided. In amputations two inches below the head of
the fibula, two main arteries, the anterior and posterior tibial,
are divided. In amputations three inches below the head, three main
arteries, the two tibials and the peroneal, are divided.
Public-domain text, read in full here on John Shaqi.
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