Book One -- The things that sustain and support the entire body, and what braces and attaches them all. [the bones and the ligaments that interconnect them]

Chapter 33 On the Bones of the Foot

[Figures of Chapter 33]



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Legend of the thirteen figures of the present chapter, and their characters.
The first figure represents the whole structure of the bones of the right foot in their upper [dorsal] surface. The second sets forth the construction of bones of the right foot also, drawn from the side [plantar] on which we rest when standing. In the third, the talus of the right foot is presented to the eyes in its anterior face so that its upper [dorsal] part comes into view. In the fourth, the lower [plantar] side of the same talus is represented from its anterior surface. It the fifth, the talus is viewed from its inner [medial] side. The sixth brings to view the talus drawn in its outer [lateral] side. In the seventh, the bone of the heel [calcaneus] of the right foot is so represented in its inner 1 side that its outer side shows more than its inner. In the eighth, the heelbone is shown in its inner side. 2 The ninth shows the heelbone from its outer side, and like the two preceding figures represents the upper surface of the heel. 3 In the tenth, the bone of the foot resembling a boat [os naviculare] is seen illustrated in its anterior [distal] face, where it is joined to the bones of the tarsus. 4 The eleventh is the posterior [proximal] surface of the same bone. In the twelfth is beheld the anterior [distal] face of the four bones of the tarsus joined together, to which the bones of the metatarsus are attached. In the thirteenth is viewed the posterior surface of the four bones of the tarsus, coterminous to the heel and the navicular bone.

G 1, 2 Talus
D 1, 2 Heel [calcaneus]
Q 1, 2 Bone resembling a boat [os naviculare]
1, 2, 3, 4[ 1, 2 , 12, 13 ] These numbers in the first, second, twelfth, and thirteenth figures mark the four bones of the tarsus which we name from the number written on them, calling this one the first, that one the second, and so on. 5
I, II, III, IIII, V[ 1 ] Five metatarsal bones 6 are marked in the first figure; they are seen also in the second, unmarked by characters.
L, C 1, 2 Bones of the digits of the foot [phalanges proximales].
A, B, C, D 3, 5, 6 By these four characters is marked the prominence of the talus [trochlea tali] that is articulated to the lower epiphysis [facies articularis inferior et malleolus medialis] of the tibia. A to B indicates the first rib or side [medial] of this prominence; C to D is the second [lateral], A to C the third [distal], B to D the fourth [proximal].
E, E 3 Depression in the prominence of the talus, carved along its longitude.
F, F 3 Two parts of the prominence of the talus [trochlea tali, facies superior], standing out higher than the depression marked E.
G 5 Inner side [facies malleolaris mediale] of the prominence of the talus, compressed and coated with cartilage which is connected to the inner malleolus [tibia, malleolus medialis].
H 6 Depression in the prominence of the talus situated on its outer side [facies malleolaris lateralis]; likewise covered with cartilage, it receives the outer malleolus [fibula, malleolus lateralis].
I 5 Rough depression of the talus, into which is inserted a cartilaginous ligament 7 proceeding from the inner malleolus.
K 6 Depression of the talus into which is inserted the cartilaginous ligament [lig. talofibulare anterius] originating from the outer malleolus.
L, M 5, 6 Two depressions [sulcus tendinis musculi flexoris hallucis longi] which the posterior region of the talus shows towards the inner [medial] side, provided to bring down and deflect the tendons of the muscles 8 that pass this way to the bottom of the foot.
N 3, 4, 5, 6 Neck of the talus [collum tali].
O 3, 4, 5, 6 Head of the talus [caput tali], entering the depression [facies articularis navicularis] of the bone resembling a boat which will be marked k in the eleventh figure. 9
P 7, 8, 9 Projection or head of the heelbone [calcaneus, facies articularis talaris posterior] wrapped in cartilage, entering the depression [facies articularis calcanea posterior] of the talus to be marked Q.
Q 4 Wide depression of the talus, admitting the head of the heelbone already marked P.
R 7, 8, 9 Depression of the heelbone [calcaneus, facies articularis talaris media] into which is articulated the lower surface of the head of the talus [talus, facies articularis calcanea media], now to be marked S.
S 4 Lower surface [facies articularis calcanea anterior] of the head of the talus, which is articulated to the bone resembling a boat [os naviculare]; it enters the depression of the heelbone.


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T, T 4 Rough depression of the talus [sulcus tali], from which cartilaginous ligaments [lig. talocalcaneum interosseum] are inserted into the heelbone.
V, V 7, 8, 9 Rough depression of the heelbone [sulcus calcanei], into which cartilaginous ligaments are inserted from the just-mentioned depression of the talus.
X, Y, Z 2 Surface [plantaris] of the heelbone which faces downward when the foot is placed on the ground. Y and Z 10 in the second, Y [tuber calcanei, proc. medialis tuberis calcanei] in the eighth, and Z [tuber calcanei, proc. lateralis tuberis calcanei] in the ninth severally mark the process [tuber calcanei] of this surface suited for putting forth certain muscles; 11 it presses more closely on the ground than the remaining surface of the heelbone.
a, b 7, 8, 9 From a to b is marked the interval in the upper [dorsal] surface of the heelbone running from the posterior region of the talus [proc. posterior tali] to the rear of the heel.
c 2, 8, 9 Rear area of the heel [tuber calcanei].
d, e 2, 8 Inner [medial] side of the heel; 12 e marks an area where tendons run to the bottom of the foot. 13
f, g 1, 7, 9 Outer [lateral] side of the heel; g marks the region 14 of this side through which are extended tendons of the seventh and eighth muscles [m. fibularis longus, m. fibularis brevis] that move the foot. 15
h, i 7 In the seventh figure the anterior [distal] surface of the heel is visible; h marks the part [facies articularis talaris anterior] which is joined to the talus; i marks the part [facies articularis cuboidea] that is articulated to the bone that imitates a die or cube. It is also the low head of the heelbone that enters the depression of the bone [os cuboideum, facies articularis calcanea] that imitates a cube. This head is also visible in the ninth figure. 16
k 11 A rather deeply carved depression [facies articularis navicularis] of the bone resembling a boat [os naviculare], receiving the head of the talus marked O.
l, m, n 10 Anterior side of the bone resembling a boat, showing three very slightly prominent surfaces to which the three inner bones [ossa cuneiformia] of the tarsus are articulated.
o, p 11 and o 10 Upper [dorsal] surface of the bone resembling a boat, where it faces the top of the foot.
q, r 10 and q 11 Lower [plantar] surface of the bone resembling a boat, facing the ground; q marks the depression in this surface by which the sixth of the muscles [m. tibialis posterior, tendo] that move the foot is brought down.
s, t, u 13 Three more or less flat surfaces of the three inner bones [ossa cuneiformia] of the tarsus, by which they are articulated to the boatlike bone [os naviculare].
x 13 Depression [facies articularis calcanea] lightly carved on the surface of the cuboid bone, by which it is articulated to the heelbone. This depression is one side [proximalis] of the bone. 17
a, b 12 Surface of the cubelike bone [os cuboideum] to which the metatarsal bone [os metatarsale IV] supporting the fourth toe 18 and the bone [os metatarsale V] preceding the little toe are joined on flat surfaces. This is the second side of the cuboid bone. 19
g 12, 13 Third side [medialis] of the cuboid bone, which faces the bone resembling a boat and is joined to the third of the bones [os cuneiforme laterale] of the tarsus. 20
d 12, 13 Fourth side [lateralis] of the bone compared by professors of anatomy to a cube, facing the outer [lateral] surface of the foot.
e 12, 13 Fifth side of the same bone, situated on the upper [dorsal] surface of the foot.
z, h 2 and z 13 Sixth side [plantaris] of that bone,pressing on the ground. The h separately marks its depression, against which the tendon of the seventh muscle moving the foot is bent. 21
q 13 Process of the third of the bones [os cuneiforme laterale] of the tarsus, which is articulated to the cuboid bone; it is prominent so that the fifth of the muscles [m. tibialis posterior] that move the foot may be inserted into it. 22
i 12 Area on the innermost of the tarsal bones [os cuneiforme mediale] to which is articulated the metatarsal bone [os metatarsale I] that precedes the big toe.
k 12 To this point [facies articularis metatarsalis] on the second tarsal bone [os cuneiforme intermedium] is attached the metatarsal bone [os metatarsale II] supporting the second toe.
l 12 To this point on the third tarsal bone [os cuneiforme laterale] is articulated the metatarsal [os metatarsale III] on which the middle toe rests.
m 1, 2 Ossicle [os sesamoideum] 23 visible at the outer side of the articulation by which the metatarsal placed before the little toe is attached to the bone resembling a cube. 24
n, n 1, 2 Intervals and places [interossei] where the metatarsal bones separate from each other.
c, c 1, 2 Capitula of the metatarsal bones [caput metatarsale], entering the depressions of the first bones of the toes.
ϖ 2 Process of the metarsal bone [tuberositas ossis metatarsalis primi] that supports the big toe [hallux], into which is implanted the tendon of the seventh muscle [m. fibularis (peroneus) longus] of those that move the foot.
r 2 Process of the upper [proximal] epiphysis of the metatarsal bone [tuberositas ossis metatarsalis quinti] preceding the little toe, projecting primarily to receive the insertion of the eighth of the muscles [m. fibularis (peroneus) brevis] moving the foot.
j, t, u 1, 2 Three bones [phalanx proximalis, p. media, p. distalis] of the second toe; the same system applies to the middle, fourth, and little toe.
f, x 1, 2 Two bones [phalanx proximalis, p. distalis] of the big toe.
y, w 2 Two ossicles [ossa sesamoidea] located beneath the metatarsal bone that supports the big toe. 25
* 2 Ossicle placed before the second internode of the big toe. We have not placed marks of identification on the remaining sesamoid ossicles in the first joints of the toes. 26



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The similarity of quadrupeds to humans in their legs and feet
In the same way dogs, weasels, cats, rabbits, hares, and to a still greater degree apes and bears, 27 and all quadrupeds whose feet are split into digits, have the same kind of joint between femur and hip [articulatio coxae] and between femur and tibia 28 as humans, so, assuredly, the same structure is seen in the bones of their hind feet and man’s foot. For if you concede that the construction of the big toe is different in those animals than in man, and more or less resembles the thumb of our hand, and that their foot has sometimes more or fewer digits, and ours is shorter, 29 you will still see that the human foot 30 has no bone at all for which you will not find a very close counterpart, in situation, shape, 31 articulation, and system of motion, in dogs and animals of that kind. I call the hind foot the entire part of the limbs which we see rest on the ground when a dog or a bear raises its front legs off the ground and stands erect without leaning on a staff or any other support. I do not mean only the part that touches the ground when they stand on four feet, for that is only the digits of the feet. Likewise when we too try to move as if on four feet, we touch the ground only with fingers and toes and raise our wrist and heel from the ground like bears and dogs. 32 So it is, indeed, that in the animals just mentioned the foot begins where Aristotle imagined 33 the joint in all quadrupeds analogous with our knee. From this it is clear how much this paradox of mine about the bones of quadrupeds confounds the doctrines of Aristotle and (so far as I know) all philosophers, and of Galen, easily the prince among anatomists, about the common gait of animals in the flexion and extension of limbs, the action of sitting, the position of the femora relative to the spine or dorsum, and the erection of the body. 34 I have begun my account of the bones of the foot with this similarity of man to those animals, lest here at the beginning someone ask me things which Galen discusses in so many pages of the third book On the Use of the Parts, when he describes the foot of man as longer than that of quadrupeds, and then says that it is wide and soft. 35 So profusely does he distinguish man from the other animals in the composition of the bones, and so much trouble does he take to reason why man stands erect and sits, being more occupied in making fun of Euripides 36 than in looking at bones. Though the same features are present in man as in bears and other animals of that ilk, Galen teaches that in the construction of the foot Nature bestowed some things on man as a biped and some on him as animal endowed with reason. 37 I believe that hereafter students of Aristotle and Galen 38 will compare the bones of humans, quadrupeds, and even birds, and will investigate how we move when supported on four legs, as it were, in what manner a cat or dog 39 sits, or is supported when erect against a wall, and how they correspond or differ in each distinct feature, so that students of natural science may more correctly consider the opinions of such great men that have been studied so far and wide, and at last be admonished and recognize how manifestly the similarity of such bones refutes them, and how the anatomical doctrines of Aristotle and Galen — and even less of Plato — were not spoken by the oracle. It would take too long here to recount everybody’s opinions about the ankles and the motions of the legs, and to throw in my own view regarding each, especially when I have not yet described the bones of the foot, which I shall begin, as is fitting, from the anklebone [talus] (which the Greeks call a)stra/galoj and a)/strion). 40

THE TALUS

Its location and mode of articulation with the tibia and the fibula.
The human talus (G in figs. 1, 2, all of figs. 3-6; W to F and Y 41 in the skeletons, and next to a and b) 42 (which corresponds in shape to the talus of dogs, bears, and similar animals whose feet are divided into digits, but not of animals with a cloven or solid hoof) is contained beneath the tibia and fibula, a large portion of its surface enclosed by the epiphyses of those bones, as I have previously related in my descriptions of the tibia and fibula. 43 The upper part of the talus, which faces upward whenever the entire foot presses upon the ground, projects with a conspicuous and quite smooth tuberosity [trochlea tali, facies superior] (A-D in figs 3, 5, 6) coated with slippery cartilage [cartilago articularis] and not unlike the quarter part of a small wheel. 44 This projection of the talus is round and smooth like that part of a wheel, and ends in four sides or flanks. The first [medial] (A to B in figs. 3, 5, 6) and the second [lateral] (C to D in figs. 3, 5, 6) are brought as if in a circle at the sides of the projection along its longitude; the third [distal] (A to C in the same figures) runs along the anterior edge of the projection, the fourth [proximal] (B to D in the same figures) along the posterior edge. In such a way, this orbicular projection of the talus is somewhat quadrangular, and for this reason it is called te/trwron by the Greeks and quatrio by the Latins. 45 This projection resembles the fourth part of a small wheel not just in its sides, but like a pulley on which a rope is turned it has a rather lightly carved depression (E, E in fig. 3) in its middle, and protrudes more towards either side [trochlea tali, facies superior] (F, F in fig. 3), precisely matching the surface [facies articularis, inferior tibiae] (d, e, f in fig. 9, 10, ch. 31) which we have written is provided in the lowest surface of the epiphysis of the tibia to receive the talus. By means of this connection of the talus to the tibia we flex and extend the foot, and move it to the sides enough to be visible — though we would accomplish a more complete movement to the sides if the projection or quatrio [trochlea] 46 of the talus were carved less like a pulley and less closely articulated to the tibia;


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so it is also in dogs, where the trochlea has a more pronounced indentation longitudinally and more closely resembles a pulley on which a rope turns, and for this reason the dog’s talus is joined to the tibia by a yet stronger mutual fit. 47 This quatrio of the talus resembles the fourth part of a pulley not only in the ways we have already stated, but as the sides of the pulley’s wheel by which it is supported as if in a forked frame or, as others prefer, in a trochlea, look worn, smooth, and oiled, so too the projection of the talus is compressed at the sides where it makes contact with the malleoli [facies articularis malleoli] and is seen coated with smooth cartilage, though not in the same way everywhere. On the inner side, it is compressed in a small area [facies malleolaris medialis] (G in fig. 5) and only superficially, no doubt because the process of the tibia’s lower epiphysis that constitutes the inner malleolus and encloses this side of the talus is coated with smooth cartilage over no very wide area [facies articularis malleoli] (g in fig. 9, ch. 31). But the outer side of the projection of the talus appears broadly indented [facies malleolaris lateralis] (H in fig. 6) and coated with cartilage over a greater area to make a good seat to which the inner side of the outer malleolus, [fibula, malleolus lateralis] (h in figs. 9, 11, ch. 31), which extends farther downward than the inner malleolus, [tibia, malleolus medialis] (compare E with F in fig. 1, ch. 31), can fit perfectly. 48

Depressions of the talus by which it receives ligaments from the tibia and fibula
Just as we have written that the inner 49 side of the inner malleolus makes a rough depression [sulcus malleolaris] (k in figs. 4, 10, ch. 31) from which originates a cartilaginous ligament 50 (f in the figure for ch. 1, Bk. 2) attaching the talus to the tibia, so also the inner side of the talus is hollowed by a rough depression (I in fig. 5) to receive this ligament; the outer side of the talus is similarly carved out (K in fig. 6) so that the ligament 51 (g in the figure for ch. 1, Bk. 2) brought from the inner side of the outer malleolus may be inserted into it. Because of such ligaments, the posterior surface of the talus [proc. posterior tali] situated near the root (behind B and D in fig. 5) of the projection or trochlea is rough to admit ligaments originating from the tibia and to extend others to the calcaneus.

Depressions by which it brings down tendons
But besides roughness of this sort, the posterior area of the talus also shows depressions (L, M in figs. 5 and 6, or 1, 2, 3 in the 15th table of muscles) provided to convey the tendons of muscles which enter the bottom of the foot by this route. The tendon of the fifth of the muscles [m. tibialis posterior] that move the foot, of the muscle [m. flexor hallucis longus] that flexes the second bone of the big toe, and of the muscle [m. flexor digitorum longus] that flexes the third bone in each of the four other toes (D, E, O, P mark the muscles in the same table of muscles), descend by this route. That is the way the talus is articulated to the tibia, and how the upper and posterior areas and the sides of the talus are arranged. 52

Joint of the talus with the bone resembling a boat
From its anterior part and more from the inner side of this area, a long neck [collum tali] (N in figs. 3-6) is extended which proceeds some distance and ends in a round head [caput tali] (O in the same figs.) coated with slippery cartilage. This is articulated into the deep depression [facies articularis navicularis] (k in fig. 11) of the navicular bone, forming the joint by which we believe the foot is moved slightly and in an obscure motion to the sides, and swiveled.

Attachment of the talus to the calcaneus
The lower part of the talus is articulated to the bone of the heel by two joints, and is entirely laid upon it. One joint is situated in the posterior region, where the heelbone projects in a wide, ample tuberosity [calcaneus, facies articularis talaris posterior] (P in figs. 7, 8, 9) entering the wide, deep depression [facies articularis calcanea posterior] (Q in fig. 4) of the talus. The other joint is anterior [calcaneus, facies articulares talaris anterior et media], verging toward the inner side of the foot; it is arranged differently from the posterior joint. The calcaneus is carved with an oblong depression [calcaneus, facies articularis talaris media] (R in figs 7, 8, 9) which is coated with cartilage and receives the lower part [facies articularis calcanea media] (S in fig. 4) of the head of the talus. The head of the talus (O in fig. 4), articulated with the navicular bone, is precisely fitted on its lower surface [facies articularis calcanea anterior] to the depression of the calcaneus [facies articularis talaris anterior] just mentioned where it rests upon the heelbone with a low projection. 53

Depression appearing between the attachments of the talus with the calcaneus
Between these articulations, the talus (T, T in fig. 4) [sulcus tali] and the calcaneus (V, V in figs. 7, 8, 9) [sulcus calcanei] are both made rough and have deep depressions from which originate cartilaginous ligaments [lig. talocalcaneum interosseum] very powerfully binding the talus to the calcaneus. The rough depressions in these bones are so deeply incised that when the bones are cleaned and afterwards reassembled a large space [sinus tarsi] lies open there between the talus and the calcaneus, which is filled in the living with cartilaginous ligaments [lig. talocalcaneum laterale, lig. talocalcaneum mediale] of the sort which bind the talus to the calcaneus so tenaciously that it can scarcely be moved at all and is as immovable on its lower surface [articulatio subtalaris] as it can be seen to twist and turn freely on its upper surface where it is articulated [articulatio talocruralis] with the tibia.


THE CALCANEUS

The side facing the ground
The heelbone 54 (D in figs. 1-2 and all of figs. 7-9; a in skeletons 2, 3), which is easily the largest of all the bones of the foot and is made of the same substance as the talus, is smoothly rounded 55 in the part on which we step [tuber calcanei] (X, Y, Z in fig 2), but it is also somewhat wide for the sake of a safe design. But at the same time, it is rough and irregular thereabouts on account of certain muscles. 56 First, it projects transversely downward near the back on its lower [plantar] surface and puts forth a rough process (Y, Z in fig. 2, Y in the 8th, Z in the 9th) 57 from whose anterior surface begins a muscle [m. flexor digitorum brevis] (Q in the 14th table of muscles) which flexes the second bone of the four digits [phalanges mediae] of the foot. A muscular substance [m. quadratus plantae] (l, m in the 14th table of muscles, N in the 15th) also originates from here, which produces four sections of muscle by which we adduct the four digits toward the big toe. In order to put forth these muscles, this lower [plantar] surface of the calcaneus is wide and irregular, and the process [tuber calcanei] projects and comes closer to the ground than the remaining body of the calcaneus so that the heads of the muscles will not be compressed in treading the ground.

The upper surface of the calcaneus, brought backward beyond the straight line of the tibia
The upper [dorsal] surface of the calcaneus, which runs from the posterior part of the talus [proc. posterior tali] to the back of the heelbone itself (a to b in fig. 7), presents the appearance of a smooth body, showing nothing special except a slight roughness into which ligaments of the tibia and the talus are inserted. 58 It is free from the origin or insertion of muscles, and from articulation. This posterior surface of the heelbone goes somewhat beyond the axis of the tibia, being extended posteriorly so that the tibia may be advantageously supported on the foot like a perpendicular line on another line drawn horizontally beneath it, and so the strongest tendon of the entire body [tendo calcaneus] (l in the 13th table of muscles, or the tendon combined from n, o, q in the 14th table) may be inserted in the posterior part (c in figs. 2, 8, 9) of the calcaneus. To this low and quite rough part 59 of the calcaneus the tendon is inserted that is combined from the first, second, and fourth


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muscles that move the foot. 60 In quadrupeds such as dogs, sheep, and horses, this posterior part of the heelbone also claims an oblong depression where the tendon is safely conveyed which in those animals, unlike humans, produces a broad tendon growing up from the skin of the sole.

The inner side of the calcaneus
Of the sides of the calcaneus, which are wide and flat, the inner [medial] one (d, e in figs. 2, 8; e marks the depressed surface) is smooth and visibly depressed to make it a fit place for the tendons of muscles 61 going this way to the bottom of the foot which are quite securely bent back upon this inner side of the heelbone. In addition to the principal vein, artery [a. & v. tibialis posterior] (d in the last figure of Bk. 3), and nerve [n. tibialis] (w in the last figure of Bk. 4) to the bottom of the foot, the tendon of the fifth muscle moving the foot (k in the 14th table of muscles) and the tendons (e,h in the 14th table) of two muscles [m. flexor digitorum longus, tendo] [m. flexor hallucis longus, tendo] that flex the last joints of the digits of the foot are led down by this route. These tendons are turned chiefly on the posterior surface of the process of the calcaneus where Nature has carved a depression [calcaneus, facies articularis talaris media] (R in figs. 7, 8, 9) 62 receiving the head of the talus, forming the anterior joint of the talus with the heelbone. This process [sustenaculum tali] projecting into the inner side of the foot makes the inner [medial] side of the calcaneus quite concave 63 in the same way that the protruding inner side [tuber calcanei, proc. medialis tuberis calcanei] (Y in figs. 2, 8) of the posterior part of the heelbone also substantially augments this hollow. It also projects significantly so that the muscle [m. abductor hallucis] (xr in the 6th table of muscles) by which the big toe is abducted inward away from the other toes may originate from here.

The outer side
The outer [lateral] side (f, g in figs. 1, 7, 9) of the calcaneus is not concave, but rough, irregular, and unfleshed with the exception of its lower surface [tuber calcanei, proc. lateralis tuberis calcanei] (Z in figs 2, 9) which puts forth a small muscle [m. abductor digiti minimi] (P in the 2nd table of muscles, u in the 14th) that abducts the little toe from the others toward the outside. The anterior portion (g in figs. 1, 7, 9) 64 of this side is in some of its area smooth and very slightly concave on its surface, making room for tendons of the seventh and eighth muscles [m. fibularis longus, m. fibularis brevis] (F and Y in the 6th table of muscles) that move the foot, which are bent back upon the posterior surface of the outer malleolus [malleolus lateralis] (w in the 6th table) and run along this region of the calcaneus.

The anterior part of the calcaneus
Of the anterior parts of the heelbone, that one [facies articularis talaris anterior] (h in fig. 7) which is on the side of the big toe and goes out like a process into the inner side of the bone, is articulated to the talus in the manner previously stated and is contiguous to no other bone. But the anterior part [facies articularis cuboidea] (i in figs. 7, 9) of the calcaneus corresponding in its placement to the little toe is smooth on its anterior face, coated with slippery cartilage, and projects in a low, wide head which is articulated with a concavity [facies articularis calcanea] (x in fig. 13) of the bone resembling a cube [os cuboideum] which is likewise covered with slippery cartilage and is only superficially incised. This joint is made by the type of attachment which we have said is called a)rqrwdi/a by the Greeks. 65


THE NAVICULAR BONE

Concavity of the navicular bone
The navicular or boat-shaped bone (Q in figs. 1, 2 and all of figs 10, 11; b with W and d, e, f in the skeletons) has a rather deep depression [facies articularis navicularis] (k in fig. 11) in its posterior [proximal] surface, for which the Greeks called it skafoeide/j because of its boatlike appearance. This concavity (as has previously been stated) receives the head (O in figs. 3, 4) of the talus.

The anterior surface of the bone, and its three flat surfaces
The anterior [distal] surface of the bone resembling a boat is coated with slippery cartilage, and shows two very slightly prominent surfaces (l, m, n in fig. 10) provided for the three bones of the tarsus [ossa cuneiformia] (1, 2, 3 in figs. 1, 2, 12, 13) which are articulated to it and protrude so slightly that you can scarcely distinguish whether they are depressions or heads. The innermost of these surfaces [facies articularis, os cuneiforme mediale] and the closest to the inside of the foot is broader than the other two and more prominent because the tarsal bone [os cuneiforme mediale] articulated to it is larger and wider; it [os cuneiforme mediale] is also more deeply concave than the two other bones of the tarsus [os cuneiforme intermedium, os cuneiforme laterale] which are joined to the other two surfaces of the navicular bone. Experts at dissection call these smooth and very subtly protuberant surfaces “cubes” 66 whenever they explain that three bones of the tarsus are attached to the cubes of the bone that resembles a boat.

The superior surface
The superior [dorsal] surface (o, p in fig. 11, o in 10) of this bone is arched and more or less round 67 like a small wheel, having a shape which was best in this part of the foot and more durable in resisting injuries. This surface is quite rough everywhere, the better to put out ligaments [ligamentum talonaviculare] connecting it to the talus and the bones of the tarsus.

The inferior surface
The inferior [plantar] surface (q, r in fig. 10, q in 11) of the navicular bone is quite depressed 68 so as to increase the hollowness in this area which is quite necessary for the foot. But this part of the bone is rougher and more irregular than the upper, because stronger ligaments had to originate from here than from the upper side. This lower surface forms a depression (q in figs. 10, 11) next to its inner side, against which the tendon of the sixth muscle [m. tibialis posterior, tendo] (Y in the 3rd table of muscles) 69 moving the foot is most suitably bent.

Bones in the foot to which there is no corresponding bone in the hand
There is no bone in the hand corresponding to the navicular bone, nor to the talus or the calcaneus. Those in the foot that remain to be discussed correspond in some way to parts of the hand. The bones of the tarsus are of such a kind, being comparable to the carpal bones.

THE TARSUS
The Greeks give the name tarso/j to the series of four bones of the foot [ossa cuneiformia, os cuboideum] (1, 2, 3, 4 in figs. 1, 2, 12, 13; in the skeletons, d, e, f, g to b, c, and h, h) of which three are attached to the navicular bone and the fourth, which is like a cube [os cuboideum], to the calcaneus. However, the Greeks often use the name 70 not only for these bones, but they also generally refer to the entire upper part of the foot with the same word, as Galen always does in On Anatomical Procedures, writing that tendons, veins, arteries, and nerves which extend through the upper foot and go to the toes are borne along the tarsus. 71 A great many of the Latin authors also call this array of bones the planta; but since the name planta is more widely applied, I have thought it best to use the name tarsus, since the name seems more precise. 72 The analogy of the tarsus’ construction to that of the carpus (1-8 in the figures for ch. 25) is not obscure: the tarsus is comprised of four bones, the carpus of double the number. 73 For the organ of grasping needed to be assembled of more and smaller pieces, while the


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instrument of walking required larger but fewer. 74

The three inner bones of the tarsus
The three inner bones of the tarsus [ossa cuneiformia], attached to the navicular bone on more or less flat surfaces (s, t, u in fig. 13), have no special names, but many call them collectively xalkoeidh/. 75

The fourth and outermost bone
The fourth [os cuboideum], situated on the outside, has been called kuboeide/j from the shape of a cube or tessera (though it has as it were eight sides). One side of it (x in fig. 13) is posterior [proximal], where it is joined to the calcaneus [facies articularis cuboidea] (i in fig. 7). The second (a, b in fig. 12) is anterior [distal], where it will be explained it is attached to two metatarsal bones (IIII, V in fig. 1) along a continuous surface. The third [medialis] (g in figs. 12, 13) is on the inner side, where it is articulated to the adjacent bone of the tarsus [os cuneiforme laterale]. The fourth (d in figs. 12, 13) faces the outside [lateralis] of the foot, and scarcely deserves being called a side, as it is rather obscurely flat. The fifth (e in figs. 12, 13) is superior, unconnected to any bone, but facing the upper [dorsal] part of the foot. The sixth [plantaris] (z, h in fig. 2, z in fig. 13) faces the ground, and is likewise unconnected to any bone. It is considerably more irregular than the other sides, and has an oblong depression of its own [sulcus tendinis m. fibularis longi] (h in fig. 2) upon which, by the supreme cleverness of Nature, the tendon of the seventh muscle [m. fibularis longus] (V, X in the 15th table of muscles) moving the foot is turned. Because some sides of this bone are in this way obscure and irregular and it does not exactly resemble a cube, the Arabs called it grandinosum from its uneven appearance and its resemblance to a hailstone. 76 Others still because of its complex shape gave it the same name as the wedgelike bone of the head [os sphenoideum] (fig. 8, ch. 6), calling it polu/morfon. 77 This bone of the tarsus (as we have previously noted) is articulated to the calcaneus and rests on the ground; the other three, together with the navicular, are elevated above the ground in order to make the foot concave and high in this area.

The shape and size of the tarsal bones are varied
The tarsal bones (compare those in the first fig. with those in fig. 2, and figs. 12 and 13), like the carpal, vary among themselves in shape and magnitude, and they are not extended evenly in the upper and lower areas. The cuboid bone and the first bone [os cuneiforme mediale], which occupies the inner side of the foot, are much greater than the two [os cuneiforme intermedium et laterale] held in the middle, and the larger of those two is the one [os cuneiforme laterale] attached to the cuboid bone, in the same way as the cuboid is also larger than the innermost bone. In addition, the cuboid bone inclines backward toward the calcaneus, while the innermost bone projects forward, much more toward the big toe [hallux] than the others. Of the middle bones, the one [os cuneiforme intermedium] that is closest to the innermost bone is short and not extended as far forward as the one attached to the cuboid bone. All of them joined together form an upper surface that is arched and rounded and a lower one that is concave and hollow, 78 as everyone knows is also useful for the foot. The two middle bones look somewhat like a wedge: where they face the upper part of the foot, they are rather wide and rounded, and where they form the sole of the foot, they look no less acute than if they were inserted like wedges between the innermost and outermost bones of the tarsus. The tarsal bone [os cuneiforme laterale] that is attached to the cuboid is especially sharp and extends farther into the lower part of the foot than the second which is connected to the innermost bone of the tarsus, because the tendon of the fifth muscle moving the foot (D, E and c, d in the 15th table of muscles) [m. tibialis posterior] is very strongly inserted into its process (q in fig. 13), that comes down here. Where they are attached to each other on their sides, the bones of the tarsus are not covered with smooth, slippery cartilage over the whole area of the connection, but only in the posterior surface of the sides next to the navicular bone. Elsewhere they stand somewhat apart from each other, coupled together by cartilaginous ligaments. 79


AN ACCOUNT OF THE METATARSUS
A part of the foot [ossa metatarsi] (I-V in fig. 1; h, h to d, e, f, g, and i, i in the skeletons) comes after the tarsus which Hippocrates called the sth=qoj, 80 perhaps after the series of ribs, but other Greeks called it the pedi/on, the Latins planta, and some the pecten and vestigium. Since the Latin words would, if we used them, contribute much obscurity to the narrative on the muscles and descriptions of the vessels and nerves, it will clearly be helpful here too to borrow the name from the Greeks. There is also planum (which some use in translating pedi/on) in this sense, meaning a part of the foot, which is almost never heard.

The metatarsus consists of five bones
The metatarsus corresponds to the metacarpus (I-IIII in figs. 1, 2, ch. 25) of the hand, but it is made up of five bones and not of four as in the metacarpus. In the hand it was needful for the thumb to be opposed to the other digits, and for this reason its first bone is attached to the carpus by a looser joint than the four metacarpal bones. For this reason we have followed Galen in assigning the first bone of the thumb to the digits and not to the metacarpus; we attribute three bones to the thumb as well as to the fingers. 81 The five bones of the metatarsus are attached in a single series to the bones of the tarsus by an identical joint. 82 For since the foot is the organ of walking, a secure stance best suits it, requiring that bones not only of the metatarsus but also of the toes be situated in a single row.

Articulation of the metatarsus to the tarsus
The bones of the metatarsus are articulated to those of the tarsus (surfaces marked i, k, l, a, b) by smooth and only superficially protuberant heads, standing out so obscurely that you could fairly say the bones of the metatarsus are articulated to the tarsus on flat surfaces. The metatarsal bone [os metatarsale I] placed before the big toe is attached to the innermost bone [os cuneiforme mediale] of the tarsus; the one [os metatarsale II] that supports the second toe is attached to the second tarsal bone [os cuneiforme intermedium], the one [os metatarsale III] that supports the middle toe is attached to the third [os cuneiforme laterale], and the two remaining [ossa metatarsi IV-V] are connected to the cuboid bone, just as it has been stated that the metacarpal bones on which the ring and middle fingers [digitus quartus, dig. tertius] rest are attached to the eighth carpal bone [os hamatum] (III, IIII to 8 in fig. 2, ch. 25). And in the same way we have stated an ossicle (N in figs. 1, 2, ch. 25) is placed next to the outer side of the joint by which the metacarpal bone supporting the little finger is bound to the carpal bone, 83 so also an ossicle (m in figs. 1, 2) 84 is seen in the foot placed next to the outer side of the joint [articulationes tarsometatarsales] by which the fifth bone of the metatarsus is articulated to the cuboid bone. Moreover, just as the bones of the tarsus do not end on the same line in the anterior part, so too one bone of the metatarsus is extended farther back than another.


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Where the bones of the metatarsus are connected to the tarsus, they are close together on their sides and thick; at some point they are joined together by arthrodia on flat, smooth surfaces [articulationes intermetatarsales].

Intervals of the metatarsal bones
At the point where they go away from the tarsus toward the toes, they are thinner and at their middle they form intervals [interossei] (n, n in figs. 1, 2) in which is situated the muscular substance [mm. interossei dorsales et plantares] (L in the 15th table of muscles) by means of which the first joints of the toes are flexed. In order for the metatarsal bones to provide a more suitable place for this substance, they are not as sharp and thin in their upper part as where they face the ground.

Articulation with the toes
Where they [ossa metatarsi] are articulated with the toes, they everywhere resemble the metacarpal bones (C and D in fig. 1, ch. 27; look there too for the other joints); they have an epiphysis, and end in a round head (c, c in figs. 1, 2) that enters the depression of the first digital bone [phalanx proximalis]. At the point where it is articulated with the tarsus, the metatarsal bone that precedes the big toe 85 puts forth a process [tuberositas ossis metatarsalis primi] (ϖ in fig. 2) in its lower surface next to the ground, into which the seventh of the muscles [m. fibularis longus] (V, X, Y in the 15th table of muscles) that move the foot is inserted. For a like reason, the metatarsal bone supporting the little toe displays a conspicuous process [tuberositas ossis metatarsalis quinti] (r in fig. 2) projecting to the outside of the foot where it is articulated to the tarsus, into which the tendon of the eighth muscle [m. fibularis brevis] (a, then b in the 15th table of muscles) moving the foot makes its insertion.


THE DIGITS OF THE FOOT
Coming after the metatarsal bones are the the toes (L, C in figs. 1, 2; i, i to h, h in the skeletons), which are all made of three bones each [phalanx proximalis, p. media, p. distalis] (s, t, u in figs. 1, 2) like those that are in the hand, the big toe alone excepted. Among the others, it [hallux] alone is made of only two bones (f, x in figs. 1, 2) so that the anterior part of the foot’s concavity will press more firmly on the ground. 86 For this purpose the large ossicles [ossa sesamoidea] (y, w in fig. 2) also help considerably, which were said to lie at the first internode of the big toe when I described the sesamoid bones. 87 In that chapter I dealt no less with the ossicles of the hand than with those of the foot (since both work in the same way).

The foot has one bone less than the hand, contrary to Galen’s view
It is clear that the foot is one bone short of the number in the hand. The hand consists of twenty-seven bones, not counting the sesamoids. There are eight carpals, four metacarpals, and fifteen digital bones. The foot, however, has just twenty-six bones: the calcaneus, the talus, the navicular bone, four tarsal bones, five metatarsals, and fourteen toe bones. I believed this should be added on account of Galen, who writes in the second book of Commentaries on Hippocrates’ book “On Fractures” (where he says that the human foot is made of many small bones no differently than the hand 88 ) that there are twenty-seven bones in the foot just as there are in the hand; 89 little thinking, by Hercules, that he was counting the cuboid bone twice, or four other tarsal bones besides the cuboid. He does likewise in the same book when he says 90 that the four bones of the tarsus are articulated to the cuboid bone and the navicular bone. 91 But let this suffice about all the bones of the human fabric. 92 Let us now consider the nails and cartilages, which still remain if everything that strengthens, supports, and sustains the body is to be completed as was undertaken.



Book One -- The things that sustain and support the entire body, and what braces and attaches them all. [the bones and the ligaments that interconnect them]