The Significance of the scaphoid tubercle of the foot as a bony landmark / by Henry O. Feiss.

  • Feiss, Henry Otto.
Date:
1909
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Licence: Public Domain Mark

Credit: The Significance of the scaphoid tubercle of the foot as a bony landmark / by Henry O. Feiss. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    tion. The first task then is to select proper bony landmarks and such a task becomes quite simple after its original conception. In the selection of bony landmarks of the foot we naturally turn to its inner aspect because it is on this side that the changes in the arch are most apparent. Starting in front the only landmark representing the anterior part of the arch is the lower tubercle on the inner side of the head of the first metatarsal bone. This tubercle can always be felt. Posteriorly, the best landmark is the internal malleolus. This, to be sure, is not a part of the foot itself but its relationship to the foot is easily comprehended. It is also true that this relationship is not a fixed one because it travels backwards when weight is borne on account of the rotation of the tibia (it also travels slightly downward and inward), but as this movement may be clearly analyzed it need not confuse our estimation. With regard to the arch itself, the clearest and most logi- cal landmark which presents itself is the tubercle of the scaphoid bone.* This tubercle is almost always pronounced and after practicing palpa- tion on a few dozen cases it can usually be distinguished by its peculiar shape and position from such lesser tubercles as that on the internal cuneiform bone, on the head of the astragulus and the sustentaculum tali. I admit that in certain deformities which are marked the head of the astragulus and the sustentaculum tali are liable to delude us, but if we recognize this liability and keep it in mind then in the ordinary type there will be little danger of being led astray. A Closer Scrutiny of the Selected Landmarks Before advancing let us briefly examine more closely the land- marks that have been selected, as it is absolutely essential that the observer knows definitely just what part of the skeleton his finger touches in his examination. The figure (Fig. i) appended is a wash drawing of a disarticulated skeleton which brings into exaggerated relief the landmarks in question. The Lower Tubercle of the Head of the First Metatarsal Bone In examining the head of the first metatarsal bone in the disarticu- lated skeleton we find on its inner aspect two ridges separated by a groove. Each of these ridges ends posteriorly in a prominent tubercle. The upper tubercle does not concern us, the lower one is sharp and is the one which applies to the present series of observations. The only author that I know of who calls attention to the relationship of the scaphoid tubercle as a bony landmark is Deaver in his Surg. Anat, Pg. 548, Vol. Ill, who refers to it as being placed 1 inch in front and a little below the inner malleolus. Other anatomists simply mention it as a bony landmark in connection with other landmarks of the foot.