258_Chapter 7_Lower Leg, Foot, and Ankle
Figurę 7-16. HagluncTs deformity (arrow).
Lower Leg. The surface anatomy of the medial leg is quitc straightforward (Fig. 7-23). From this perspective, the anterior portion of the leg is defined by the straight margin of the subcutaneous border of the tibia, whereas the posterior margin is defined by the contours of the soleus and the medial head of the gastrocnemius.
Plantar Aspect
Of course, the plantar aspect of the foot must be examined when the patient is not bearing weight on it (Fig. 7-24). However, careful inspection of the skin of the plantar surface allows the examiner to deduce information concern-ing the function of the foot during weightbearing. Areas of thickened or callused skin should be noted becausc they reflect the weightbearing pattcrn of the foot and can thus help identify areas of excessive weightbearing. Such areas of thickened skin commonly occur along the lateral foot and underneath the metatarsal heads. Intractable plantar keratosis is the term usually applied to the freąuently painful accumulations of callused skin that can form beneath the metatarsal heads (Fig. 7-25). The formation of these keratoses is usually secondary to deformities of the toes. In hammer toe or clctw toedeformities, the associ-ated hyperextension of the metatarsophalangeal joint
Figurę 7-17. A, B, and C, Posterior aspect of the leg. A, soleus; B, medial gastrocnemius; C, lateral gastrocnemius; D, usual site of gastrocnemius tear.