The Tendons

It is difficult to identify the position of the tendons, especially if one does not know where to look for them.

The tendo calcanetis (Achillis) is usually easily recognized, as it can be made tense, even in fat, chubby children, by dorsally flexing the foot.

The flexor longus digitorum and flexor longus hallucis lie too deeply behind the internal malleolus to be recognized; the latter is the more posterior.

The tibialis posterior, on strongly abducting the foot, can often be seen and felt along the posterior border of the internal malleolus and between the latter and the tubercle of the scaphoid, into which it inserts.

The tibialis anterior is the tendon nearest the anterior edge of the internal malleolus. It runs down to the internal cuneiform bone about 2.5 cm. (1 in.) in front of the tubercle of the scaphoid.

The extetisor longus hallucis lies just to the outside of the tibialis anterior and can often be made prominent by flexing the big toe.

The extensor longus digitorum tendons at the ankle lie close together just outside of the extensor longus hallucis. The peroneus teriius runs from them to the dorsum of the fifth metatarsal bone a little in front of its base.

The peroneal tendons can usually be made visible by sharply adducting the foot. The brevis is then seen running back to the peroneal spine 2.5 cm. (1 in.) below and a little in front of the external malleolus and from this point up to behind the malleolus; in thin people both the brevis and longus can be seen and followed up the lower part of the fibula.

The soft rounded prominence about 5 cm. (2 in.) in front of the external malleolus is the extensor brevis digitorum muscle.

The Joints

The ankle-joint lies 1.25 cm. (1/2 in.) above the tip of the internal malleolus.

The midtarsal (Chopart's) joint is best found on the inner side of the foot; here it passes immediately behind the tubercle of the scaphoid. On the outer side it is approximately at the middle of a line joining the external malleolus and tuberosity of the fifth metatarsal bone. At this point there is frequently a bony prominence formed by the anterior edge of the os calcis.

The tarsometatarsal (Lisfranc's) joint is best found on the outer side of the foot. It lies immediately behind the tuberosity of the fifth metatarsal bone, between it and the cuboid.

Its inner extremity can be found either by following up the first metatarsal bone from its head for about 5 cm. (2 in.) when a ridge of bone will be felt on its base, the joint being immediately behind it; or by identifying the tubercle of the scaphoid and allowing 2.5 cm. (1 in.) from its anterior edge for the internal cuneiform bone. Its exact location is to be recognized by pressing with the edge of the thumb at the suspected spot and moving the metatarsal bone with the opposite hand.