Anatomy Lesson #61: Jamie’s Mars and Scars

Hallo, anatomy students. First lesson posted in a while – I have been waiting for new S4 material!

Meantime, “Me keep do.”  So, here’s one last lesson from S3.  Welcome to Anatomy Lesson #61, Jamie’s Mars and Scars!

Getting right to it…. Many events transpired in ep 306, A. Malcolm, wherein Jamie meets Claire after two hundred and twenty-two years apart. Woot!

Like you, the intimate scenes of this episode immediately drew my eyes to Jamie’s body –  Oops, I mean his mars and scars. Come on, I’m a scientist! 

My anatomist’s eye immediately began calculating… Weil, actually not until the second viewing, but you get my drift…. Are Jamie’s scars all present? Are any scars missing? Are they accurately depicted? Did they change?

What say you, Outlander fans, shall we investigate?

This is a chronological list of injuries over three seasons of Outlander TV and most produce scars. All but one appear in the books. Do you ken the outlier?

  1. dislocated shoulder joint
  2. gunshot wound, front
  3. gunshot wound, back
  4. BJR backlash
  5. McDonald’s sword work
  6. BJR hand smashing
  7. BJR burn
  8. BJR Culloden scar

Truly, this red-heided lad has suffered his share of owies! 

We are all too aware of horrific wounds from modern warfare, but battlefield wounds have always been appalling. In the 16th century, French barber surgeon Ambrose Paré became famous for his ingenious repairs of battlefield injuries. One of his famous illustrations is a composite drawing that depictes the range of wounds suffered by warriors of the past (Image A). Seems as if our Jamie may have posed for this image. Gasp!

Image A

Just for fun and because you have nothing else to do <g>, let’s explore the laundry list of Jamie’s Wounds.  We’ll jump backward and forward 20 years as we analyze his mars and scars in chronological order.

Strap yourselves in. Here we go!

1. Dislocated Shoulder Joint:

Claire first spies Jamie perched atop a stool in a crofter’s cottage (Starz ep 101, Outlander). His hunched form cradles right forearm. Her keen nurse’s eye is horrified by his injury. Here from Outlander book:

I gasped, as did several of the men. The shoulder had been wounded; there was a deep ragged furrow across the top, and blood was running freely down the young man’s breast. But more shocking was the shoulder joint itself. A dreadful hump rose on that side, and the arm hung at an impossible angle.

Q: What happened to Jamie?

A: He suffered an anterior dislocation of the right shoulder joint.

His fellow Highlanders move to force the joint into place but Claire-Declares, NO!  No qualified chirurgeon in this grubby group of lads!

The dreadful “hump” is the acromion, a feature of the scapula (shoulder blade). Read about the shoulder joint and Claire’s treatment of its dislocation in Anatomy Lesson #2, When Claire Meets Jamie or How to Fall in Love While Reducing a Dislocated Shoulder Joint!

Footnote #1: In Outlander book, Jamie suffered both a dislocated shoulder and a gunshot wound. Diana wrote that the musket ball knocked him from the saddle and he fell on his hand. Crunch went the shoulder joint! 

Outlander ep 101, Sassenach

Although bruising and swelling often accompany such dislocations, both may resolve without sequelae. Jumping forward 20 years, witness Jamie’s fine form at the brothel reunion in Starz ep 306, A. Malcolm. Evidence of a shoulder dislocation? Nada! Fortunately for Claire, this shoulder works perfectly fine. In fact, everything works perfectly fine. Wink, wink!

Outlander ep 306, A. Malcolm

Before we leave the shoulder issue, several fans have asked if the TV depiction of Jamie’s dislocation is realistic. Well, mostly. An actual anterior dislocation of the shoulder joint looks like Image B (left shoulder). Here, the rounded contour of the shoulder is lost because head of the humerus has been displaced forward into the armpit area (axilla).  The bony knob (red arrow) is the acromion but, clearly, it is not as prominent as depicted in the TV version.

The difference can be explained because in the TV episode, the “dreadful hump” was a prosthetic applied to the top of Jamie’s shoulder. Thus, the hump sits higher and appears more prominent than in life. But, otherwise, kudos to the special effects team!

Image B

Moving on!

2. Gunshot Wound, Front:

Back to the crofter’s cottage! Hightailing it towards home, the Highlanders are ambushed by Redcoats at Cocknammon Rock. But, the English are swiftly dispatched. Hours later, Claire shouts:

“Stop! Help! He’s going over!”

Timber!!! – Jamie topples from his steed.

Claire swiftly discovers a gunshot wound. Jamie, why didn’t you fess up? Now, Claire must deal with a nasty hole left by a musket ball plowing a path through Jamie’s trapezius muscle! Claire explains to Dougal’s merry band of men (Outlander book): 

“The gunshot wound has been bleeding again, and the idiot’s been knifed as well. I think it’s not serious, but he’s lost quite a lot of blood. His shirt is soaked through, but I don’t know how much of it is his. He needs rest and quiet; we should camp here at least until morning.” 

Fat chance Dougal will stop for his nephew to rest; not with Captain Randall prancing through the heather.

“On your feet, soldier!” 

Footnote #2: The TV version shifted the gunshot wound later in the episode and completely ignored the knifing. Probably figured Claire had enough on her plate. Hah!

Outlander ep 101, Sassenach

Fast forward 20 years: Delightful! Starz FX team remembered to include a faint scar as evidence of that entrance crater left by the musket ball. 

Can’t you just see a Starz employee with a wound list?

  • Dislocated shoulder joint, check!
  • Front gunshot wound, check! (
  • etc.

Outlander ep 306, A. Malcolm

3. Gunshot Wound, Back:

Back to the past. Next morning, in Castle Leoch’s keep, wary Claire meets-and-greets wary Mrs. Fitz – immortalized  in this masterful excerpt from Outlander book:

“But he’s hurt. He was shot yesterday and stabbed last night. I bandaged the wound for riding, but I didn’t have time to clean or dress it properly. I must care for it now, before it gets infected.” 

“Infected?”

“Yes, that is, I mean, inflamed, you know, with pus and swelling and fever.”

“Oh, aye, I know what ye mean. But do ye mean to say as ye know what to do for that? Are ye a charmer then? A Beaton?”

“Something like that.”

This terse little tête-à-tête, wherein WWII combat nurse and 17th century castle housekeeper face-off, reveals Claire’s nimble brain! The term infected, meaning invasion by micro-organism, won’t come into common use for another century. Oops, she quickly course-corrects! 

Then, off she goes to properly tend Jamie. (One might think the lad is accident prone!)

The wound at back of shoulder marks the exit site of the musket ball. Serious bruising from gunshot wound and dislocated shoulder and horrific criss-crossing scars (see below) definitely catch her eye. Eek!

Outlander ep 102, Castle Leoch

Spring forward 20 years. Was the exit wound depicted at the brothel reunion? Aye, it was. Take a really close keek at Jamie’s back….there it be (red arrow).

Psst…let’s just ignore the unfortunate pleating of Jamie’s back prosthesis – best save those pleats for his kilt.

Outlander ep 306, A. Malcolm

Next!

Back to Castle Leoch. We can consider Rupert’s hearty beating of Jamie who gallantly choses fists over strap (enough straps) to protect loose-behaving Missy Laoghaire. Once again, mars are treated by Outlander Nurse. But, none of these blows caused permanent damage, so let’s move on!

Outlander ep 102, Castle leoch

4.  BJR Backlash:

Just right for Hallowe’en – foul work by a foul one! Fast forward to ep 106, The Garrison Commander, wherein Captain Blackguard informs Claire of his beautiful masterpiece. Produced four years earlier, BJ floged Jamie’s back into a bloody mess using a cat-‘o-nine tails with lead tips. Yep, these do leave scars!  And, dinna forget, Jamie already had been flogged days earlier! 😳

If you can stomach more flogging details, read Anatomy Lesson #10, Jamie’s Back – Aye, Jamie’s Back!

Described by Dougal in Outlander book: 

Dougal grimaced. “A pitiful sight, it was, too—still raw, no more than half-healed, wi’ the weals turned black and the rest yellow wi’ bruises. The thought of a whip comin’ down on that soreness was enough to make me blench, along wi’ most of those watching.”

Outlander ep 106, The Garrison Commander

So naturally, the back scars persist two decades later.

A splendid quote from Voyager book; Jamie’s scars have healed and contracted as scars normally do. 

I curled up behind him, knees fitting neatly behind his own. The firelight shone dully from behind me now, gleaming over the smooth round of his shoulder and dimly illuminating his back. I could see the faint lines of the scars that webbed his shoulders, thin streaks of silver on his flesh. At one time, I had known those scars so intimately, I could have traced them with my fingers, blindfolded. 

Footnote #3: To my eye, the prosthesis at Madam Jeanne’s establishment appears identical to the original. Over a 20-year span, such scars should contract and thickness diminish.  I suggest a new prosthesis to document these changes, an expected progression of wound healing and scar formation.

Outlander ep 306, A. Malcolm

5. MacDonald’s Sword Work:

Back to the early years. Ye ken the MacDonald clan with its three nasty-mouthed bros? Best ignore them, Jamie.

Nope. He gives them sass and in return, suffers a slice and dice Big Mac Attack! Three against one? No fair!

Outlander ep 110, By The Pricking of My Thumbs

The moral to this event is arguable, but consider something along the line of: dinna get mouthy with the MacDonald clan, especially if three well-armed laddies are against one!

But, Jamie exacts his revenge as he slices the hamstrings of one attacker, who from henceforth will hobble. And, who is cowering behind the tree? The cowardly Duke, who soon has a fate-date with The Godfather! Yes!!!

Outlander ep 110, By The Pricking of My Thumbs

Later, Claire stitches Jamie’s sword wound using the biggest needle she can find – royally POed!  Most of you ken that she accidentally stuck that needle into “Jamie’s” skin during filming. Och! 😱

Footnote #4: If you chose this as the only injury not in the books, score! Although Diana didn’t write the MacDonald fight, Jamie does suffer a saber-slash at Prestonpans. Here from Dragonfly in Amber:

It was a saber-slash, slanting across the ribs. A lucky angle; straight in and it would have gone deep into the intercostal muscles between the ribs. As it was, an eight-inch flap of skin gaped loose, red beginning to ooze beneath it again with the release of pressure. It would take a goodly number of stitches to repair, but aside from the constant danger of infection, the wound was in no way serious.

Outlander ep 110, By The Pricking of My Thumbs 

Did the Outlander FX team include the scar from the Sandringham kebby-lebby? Yep! There it is basking in Claire afterglow!

Outlander ep 306, A. Malcolm

6. BJR Smashing:

You ken about smashing pumpkins? BJR has his version, whacking Jamie’s hand with a mallet, smashing metacarpals and phalanges.  

Read more about BJR atrocious pastimes in Anatomy Lesson #22, Jamie’s Hand – Symbol of Sacrifice!

Outlander ep 115, Wentworth Prison

Once again, Claire to the rescue! She stitches Jamie’s wounds and splints broken metacarpals and phalanges. Herself clearly explains the fate of Jamie’s paw after BJR’s maniacal ministrations (Outlander book):

I began to lose myself in the concentration of the job, directing all my awareness to my fingertips, assessing each point of damage and deciding how best to draw the smashed bones back into alignment. Luckily the thumb had suffered least; only a simple fracture of the first joint. That would heal clean. The second knuckle on the fourth finger was completely gone; I felt only a pulpy grating of bone chips when I rolled it gently between my own thumb and forefinger, making Jamie groan. Nothing could be done about that, save splint the joint and hope for the best.

The compound fracture of the middle finger was the worst to contemplate. The finger would have to be pulled straight, drawing the protruding bone back through the torn flesh. I had seen this done before—under general anesthesia, with the guidance of X rays.

Outlander ep 116, To Ransom A Man’s soul

And, heroically repairs his mangled hand. Not a surgeon yet, but she did well!

Outlander ep 116, To Ransom A Man’s soul

Are Jamie’s finger scars visible after 20 years? Oh, indeed they are! Look closely; nothing shows them better than eating grapes.

FX peeps were on their game. Plain as the back of your hand. Not that Claire was paying much heed to those scars, mind ye. Snort!

Outlander ep 306, A. Malcolm

7. BJR Burn:

Oh, and among those grim hours in the hands of a mad man, let’s not forget the ghastly image of BJR directing Jamie to burn initials into the flesh overlying his heart. Randall offers a red hot wax stamp to “seal” the job! Gah!

Outlander ep 116, To Ransom A Man’s Soul

Those initials do not survive because TV Godfather excises them and casts  into the fiery pit. Go Murtagh! Rah! 

Footnote #5: In Outlander book, Sir Marcus removes the offending button of skin: 

“Best let me help ye, man. Ye’ll fall on it in a moment.” After a moment’s pause, Jamie reluctantly surrendered the knife and lay back against the wadded blanket. He touched his chest an inch or two below the nipple. “There.” 

Sir Marcus reached to the sideboard and snagged a lamp, setting it on the stool he had vacated. At this distance, I couldn’t see what he was peering at; it looked like a small red burn, roughly circular in shape. He took another deliberate pull at his whisky glass, then set it down next to the lamp and pressed the tip of the knife against Jamie’s chest. I must have made an involuntary movement, because the Lady Annabelle clutched my sleeve with a murmured caution. The knife point pressed in and twisted suddenly, flicking away in the motion one uses to cut a bad spot out of a ripe peach. Jamie grunted, once, and a thin stream of red ran down the slope of his belly to stain the blanket.

Talk about branding! Deeply grateful, today’s entrepreneurs never met Johnathan Wolverton!  

Outlander ep 116, To Ransom A Man’s Soul

Back at the brothel, the burn scar is on full display (red arrow), looking a bit like a supernumerary nipple! He, he. The Starz crew didna forget!

Outlander ep 306, A. Malcolm

And, finally, the last wound!

8. BJR Culloden Slash: 

Black Jack is at it again – fiendish fiend! At Culloden, Jamie glances away from a fallen Randall and swish, the blackguard’s blade strikes and bites verra close to Jamie’s femoral artery! 

Outlander ep 301, The Battle Joined

Twenty years later after the reunion-union, Claire espies the long thigh scar. Not quite as described in Voyager, but close. Outlander team snagged this one, too!

The scar ran from midthigh nearly to his groin, an eight-inch length of twisted, whitish tissue. I couldn’t repress a gasp at its appearance, and dropped to my knees beside him. I laid my cheek on his thigh, holding tight to his leg, as though I would keep him now—as I had not been able to keep him then. I could feel the slow, deep pulse of the blood through his femoral artery under my fingers—a bare inch away from the ugly gully of that twisting scar. 

….Soft as a moth flying in the dark, my hand skimmed his leg, and found the thin deep runnel of the scar. My fingers traced its invisible length and paused, with the barest of touches at its end, wordlessly asking, “How?”

His breathing changed with a sigh, and his hand lay over mine.

“Culloden,” he said, the whispered word an evocation of tragedy. Death. Futility. And the terrible parting that had taken me from him. 

Foot Note #6: In Voyager book, the scar extends to Jamie’s groin. The TV scar is closer to the knee – offering a modicum of modesty as millions take notice??? 😉

Outlander ep 306, A. Malcolm

So, eight wounds and FX folks nailed them all. Go team!

Think about it: BJ delivered almost 40% of Jamie’s wounds. However, if one counts each back scar, he owns well over 90% of Jamie’s mars and scars!

Oh, and here’s a wee bonus! Dinna forget loving Laoghaire’s contribution to Jamie’s landscape when the mad matron peppers him with bird shot. Of course, this event occurs after the reunion so those scars must await Season 4! Whew!  

Starz ep 308, First Wife

Let’s close with this lesson with a snippet from big book seven, An Echo in the Bone, which aptly describes Claire as Jamie’s healer and helpmeet. Not really a spoiler as it reveals no plot points.  So, safe to read.

A shadow fell across the floor in front of me and I looked up. Jamie was standing there with a most peculiar look on his face. 

“What?” I said, startled. “Has something happened?”

“No,” he said, and advancing into the study, leaned down and put his hands on the desk, bringing his face within a foot of mine.

“Have ye ever been in the slightest doubt that I need ye?” he demanded. It took roughly half a second of thought to answer this. “No,” I replied promptly. “To the best of my knowledge, you needed me urgently the moment I saw you. And I haven’t had reason to think you’ve got any more self-sufficient since. 

Outlander ep 308, First Wife

Final Points: Generally, society considers scars to be unwanted and unsightly. However, from anatomy and pathology POVs, scar formation is a normal process. Yes, indeed!  This is the way mammalian creatures typically repair tissue disruption –  like a biological bandaid. Although a scar may not perform as well as the original tissue, it keeps the body functional and responsive. To learn more about injury and repair, visit these anatomy lessons:

Recall the start of this lesson?

  • Were all scars accounted for? Yes.
  • Are any scars missing? No.
  • Were they accurately depicted? Mostly.
  • Did they change? Mostly.

Jamie’s mars and scars paint a poignant history. Claire was there for him from the get-go, treating broken bones, gunshot wounds, contusions, lacerations, incisions, dislocations, burns, and emotional abuse. Cheers to the gallant lass and her braw lad (and their creator)!

The deeply grateful,

Outlander Anatomist

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Photo Credits: Sony/Starz , adc.bmj.com (Image A); sghs.org (Image B)  

Anatomy Lesson #59: Complete Feet

Hello, anatomy students! Hello feet! Today’s anatomical offering derives from the Old English fot, meaning “foot.” 

You might think Outlander has little to say about feet, but not so. Outlander has fleet feet, sweet feet, trick-or-treat feet, body heat feet, upbeat feet, mincemeat feet, eek feet, beat feet and indiscrete feet. As always, Outlander images and quotes are sprinkled throughout the lesson. Yay!

You might also think society has little to say about feet, but not so. Dozens of feet adages accent life’s little highs and lows:

  • Foot in both camps (fence sitter)
  • Ankle deep (in trouble)
  • Back on your feet (on the mend)
  • Bound hand and foot (hampered)
  • Cold feet (lost interest)
  • Get your feet wet (get involved)
  • Drag your feet (unenthusiastic)
  • Feet of clay (flawed)
  • Foot in mouth (oops!)
  • Keep feet on the ground (be sensible)
  • Footloose (6 degrees of Kevin Bacon)

As a grad student, my gross anatomy prof declared feet the ugliest body part! Beauty being in the eye of the beholder aside, our foot is far more specialized than our hand as no other animal has a foot quite like ours! I hold with the master, Leonardo DaVinci who opined: 

The human foot is a masterpiece of engineering and a work of art.

Yes!    

Understand, the human foot is a truly complex mechanical structure consisting of 26 bones, 33 joints, and more than a hundred muscles, tendons, and ligaments! Despite this complexity, our feet usually work pretty well, especially if we care for them.  Also, know this lesson is geared for general readers, so the most complex features and smallish details are not covered.

Before we begin the lesson, let’s take a gander at Claire’s fleet feet (Outlander ep 101 Sassenach) as she retreats from redcoat muskets firing live rounds! Her poor heels are rubbed raw from running – leather shoon sans sox. Not a good plan, but did the lass have another choice? Och!

Foot: Always prudent to begin a lesson with definitions. In anatomy, the foot is the lower limb below (distal to) the ankle joint (Image A –  blue line).

Orienting ourselves further, the top of foot is the dorsal surface; the bottom (sole) is the plantar surface. Inner side is the medial surface and the outer side is the  lateral surface.

 

Image A 

Skeleton: We begin with the foot skeleton, a foundation of 26 bones. Image B shows bones of a right foot, 26 in all. The left panel shows bones from the bottom or plantar perspective. The right panel shows foot bones from above, the dorsal view.

Toe bones are homologous to digits of the hand (Anatomy Lesson #22, Jamie’s Hand – Symbol of Sacrifice). They are numbered 1-5 beginning with the big toe and working to the little toe.

Phalanges: Toes contain 14 phalanges (Image B, pink) – three bones per each toe, except the big toe which, like the thumb, only contains two phalangeal bones. And, the big or great toe goes by the scientific name, hallux.

Metatarsals: Five metatarsal bones (aqua) are homologous with metacarpals of the hand. 

Tarsals: Seven tarsal bones are homologous to eight carpals of the wrist, although more massive and oddly-shaped than the small carpals.  The largest, the calcaneus, is the heel bone. Atop it is the talus which helps form the ankle joint. 

There won’t be a quiz of tarsal bones <g>, but, just so you know, their names are (Image B):

  • three cuneiforms – 1, 2, & 3 (start counting on big toe side – orange)
  • cuboid (pink)
  • navicular (green)
  • calcaneus (yellow)
  • talus (blue)

 

Image B 

Need another Outlander hit? My pleasure. No, really! The morning after (he, he), Claire sports a pair of verra sweet feet (Starz ep 107, The Wedding)! Aw, look at those wee tootsies, shyly nesting. It was a big, big night! ’Nuf said! 😉

Oops, not quite, ‘nuf said. A lovely foot passage from Dragonfly in Amber book. Herself even mentions metatarsals!

“I’m honest enough to say that I dinna care what the right and wrong of it may be, so long as you are here wi’ me, Claire,” he said softly. “If it was a sin for you to choose me … then I would go to the Devil himself and bless him for tempting ye to it.” He lifted my foot and gently kissed the tip of my big toe. I laid my hand on his head; the short hair felt bristly but soft, like a very young hedgehog. “I don’t think it was wrong,” I said softly. “But if it was … then I’ll go to the Devil with you, Jamie Fraser.” He closed his eyes and bowed his head over my foot. He held it so tightly that I could feel the long, slender metatarsals pressed together; still, I didn’t pull back. I dug my fingers into his scalp and tugged his hair gently.

Divisions: Foot bones are divided into three regions. Such divisions aren’t whimsy, they are important in issues such as evaluating trauma, surgical amputation of part of all of a foot or evaluation of foot mechanics. 

  • Forefoot: Includes phalanges and metatarsals (Image C – white, left side). 
  • Mid-foot: Includes three cuneiforms, cuboid and navicular (Image C, turquoise). 
  • Hind-foot: calcaneus and talus (Image C – white, right side). 

Image C 

Ligaments: Now, the 26 foot bones don’t just hang out under the skin. They are firmly bound to each other and to our leg bones via dozens of ligaments (Image D)!

Ligaments are fibrous tissues binding bone to bone and they are critical for foot integrity because feet bear our weight against gravity! Loose or torn ligaments give folks many problems because these compromise the integrity of the skeletal system! 

Image D shows only some of the numerous ligaments anchoring and stabilizing foot bones; here, we see lateral and dorsal ligaments. The plantar and medial ligaments are not visible.

The lesson won’t discuss these ligaments in detail because they are complex and tedious, but the image dramatically emphasizes some of the many ligaments needed to stabilize the foot skeleton!

Image D 

Arches: We all know the foot has an arch, but did you know it actually has three arches (some count a 4th partial arch)? Two are longitudinal and one is transverse. The arches are maintained by interlocking tarsal and metatarsal bones, supported by ligaments and very strong tendons (image E).

  •  medial longitudinal arch (Image E – blue dashed line) extends from heel bone to first three metatarsals. Typically, it curves above the ground. When barefoot at the beach, it does not leave an imprint in sand (unless one is seriously flatfooted!).
  •  lateral longitudinal arch (Image E – green line) is a low arch arch between calcaneus and 5th metatarsal. When barefoot, it typically leaves an imprint in sand.
  • transverse arch (Image E – red line) runs across the foot at the tarsometatarsal joints (defined below).  

Although these arches are supported by strong ligaments and tendons, they exhibit some mobility when weight is applied to or removed from the foot. This springiness makes walking and running more economical in terms of energy.

Image E 

Speaking of arches, how ‘bout some booted ones! Yep, another dose to wake you students! BJR’s booted “trick or treat feet” (Starz, ep 108, Both Sides Now) will do the trick, nicely! The blackguard throws Claire over his desk preparing to further assault her. Darn! She canna reach the sgian dubh in her boot! No treat here – all vicious tricks!

Diana describes Claire’s toes just after Jamie squats in the prison window (Outlander book). 

Randall bent and scooped up the gun in a quicksilver motion. As soon as the knife left my throat, I tried to sit up, but he placed a hand on my chest and shoved me flat again. He held me down with one hand, using the other to aim the pistol at Jamie. The discarded knife lay somewhere on the floor near my feet, I thought. Now, if only I had prehensile toes.… The dirk in my pocket was as unreachable as if it were on Mars.

Plantar Aponeurosis: Remove plantar skin (very difficult on a cadaver) and a triangular sheet of connective tissue is revealed, the plantar aponeurosis. It is anchored to the calcaneus, flares in the mid-foot and ends as five (or more) bands radiating toward bases of the toes (Image F). 

The tough, fibrous aponeurosis is made mostly of collagen fibers. As such, it is a shock absorber when the foot strikes the ground. It also stabilizes arches of the foot and allows flexion at the first metatarsophalangeal joint, which carries the majority of body weight during ambulation.

If the plantar aponeurosis becomes injured or inflamed, it may cause plantar fasciatis. A painful condition common to athletes, it causes stinging foot pain that can lead to further leg injuries if untreated.

 

Image F 

Another break for Outlander! This is a splendid example of body heat feet (Starz, ep 109, The Reckoning). Things are on broil up at Castle Leoch! Claire’s right heel hooks over Jamie’s Fraser plaid….hum…. Talk about a foothold! Snort!

Joints: We have covered joints (the anatomical type) in prior lessons (e.g. Anatomy Lesson #2, When Claire Meets Jamie or How to Fall in Love While Reducing a Dislocated Shoulder Joint!).  

To reiterate, joints are sites where two or more bones meet; some are moveable and some are not. Moveable joints allow for motion and there are several types. Our 33 foot joints fall into the following categories:

  • TC Joint (1): between distal tibia, fibula and talus, a.k.a. talocrural or ankle joint
  • IT Joints (13): between tarsal bones 
  • TM Joints (5): between metatarsals and tarsals
  • MP Joints (5) : between proximal phalanges and metatarsals
  • IP Joints (9): between phalangeal bones

Reducing the technicality of this topic, we will only cover the superbly designed TC or ankle joint! The ankle joint is a mortise joint, a term used in carpentry. Here, the talus projects upwards and fits inside a three-sided bone box formed by tibia and fibula of the leg  (Anatomy Lesson #27, Colum’s Legs and Other Things, Too!). Thus, our “ankle bones” are not separate bones, they are parts of tibia and fibula.  The inner ankle bone is actually the medial malleolus of the tibia; the outer ankle bone is the lateral malleolus of the fibula. This is a highly stable hinge joint that allows movement (see below).

Image G 

Before the lesson turns to movements, let’s take a quick keek at Jamie’s upbeat feet! Cheerfully dressed in nothing but a sark, he strides to the freezing mill stream to sleuth out a prob with the water wheel (Starz ep 113, Lallybroch). Seems it is producing gritty bannocks! Upbeat feet, that is, until a mess ‘o Redcoats arrive! Notice: his right foot is lifted at the ankle, a movement known as dorsiflexion. Yep! Read on to learn more about this term.

Movements: Various movements occur at the foot joints. Some are slight; others are more generous and important for ambulation. The talocrural joint (ankle joint) allows for six movements at the ankle; the first four are demonstrated in Image H: 

  • dorsiflexion: lifting foot at the ankle
  • plantar flexion: pointing the foot at the ankle
  • inversion: turning sole medially (toward midline)
  • eversion: turning sole laterally (toward the side)
  • abduction: turning foot to side (slight)
  • adduction: turning foot toward midline (slight)

Psst…..Practitioners often prefer the terms, supination for inversion and pronation for eversion.

Image H 

Next, there are toe movements which can occur independent of the ankle joint. These involve IP and MP joints: 

  • flexion: curling the toes 
  • extension: lifting the toes
  • abduction: spreading the toes
  • adduction: returning the toes to a resting position

Image I 

Back for an Outlander scene and a collective gasp!  Jenny takes a hot poker to the sole of a redcoat captive. Ouch! The poor man now has mincemeat feet. What ya doing Jenny?

Spill, messenger! Where is my bro??? In no uncertain terms, Big Sis declares to Claire: 

Love Forces a Person to choose!

Extrinsic Muscles: First, a wee definition…long time students will remember that in anatomy the leg is the lower limb between knee and ankle joints; thigh is between hip and knee joints. Most people use the term lower leg for the anatomical leg.

Muscles acting on the foot are classified as extrinsic muscles, those originating in the leg, and intrinsic muscles, those originating in the foot.

Amazing Fact: all leg muscles, excepting one, actually act on the foot! These are so complex, they must be simplified. Yes, Image J is simplified!!!

Extrinsic muscles in Fig. J (anterior and side muscles – left panel):

  • tibialis anterior – dorsiflexes & supinates foot
  • extensor hallucis longus – extends big toe & dorsiflexes foot
  • extensor digitorum longus – extends toes 2-5 & dorsiflexes foot
  • fibularis longus & fibularis brevis – pronate & plantar flex foot

Extrinsic muscles in Fig. J (superficial posterior muscles – middle panel):

  • gastrocnemius – plantar flexes foot (cut away in image)
  • soleus – plantar flexes foot

(Note: gastroc and soleus jointly share the massive achilles tendon which inserts into calcaneus. Normally, these are extremely strong plantar flexors)

Extrinsic muscles in Fig. J (deep posterior muscles – right panel):

  • flexor hallucis longus – flexes big toe & plantar flexes foot
  • flexor digitorum longus – flexes toes 2-5 & plantar flexes foot
  • tibialis posterior – plantar flexes & supinates foot

Image J 

Whew. That was scary! Time for another Outlander treat to lower the blood pressure. Oops, this is pretty scary, too (Starz ep 209, Je Suis Prest) – yuk! It’s eek feet for puir Angus – the lad has been careless with his feet. Nurse Claire warned him to keep them dry! 

Back to anatomy. No, we are not finished with muscles. Gasp!

Intrinsic Muscles of Dorsum (top) of Foot: As stated above, intrinsic muscles arise from foot bones. There are two smallish muscles on the dorsum of the foot, not shown in Image K. 

  • extensor hallucis brevis – extends the big toe
  • extensor digitorum brevis – extends toes 2-5

Intrinsic Muscles of Plantar Foot: Believe it or not, 18 muscles are located deep to the plantar aponeurosis. Who would have thought??? These are arranged in four layers (Image K –  from left to right). If you think these look challenging, you are right. Outside the head, the foot is one of the most difficult body parts to dissect! 

First structure in Image J (left panel) 

  • Plantar aponeurosis – not a muscle

1st Layer of Intrinsic Muscles in Image J ( 2nd panel):

  • abductor hallucis – draws big toe towards midline of body
  • abductor digiti minimi (I love this name!) – draws 5th toe away from foot
  • flexor digitorum brevis – flexes toes 2-5

2nd Layer of Intrinsic Muscles in Image J (3rd panel)

  • Lumbricals – both flex & extend different phalanges of toes 2-4
  • Quadratus plantae – flexes toes 2-4

3rd Layer of Intrinsic Muscles in Image J (4th panel)

  • flexor hallucis brevis – flexes big toe
  • adductor hallucis – draws big toe towards foot
  • flexor digiti minimi brevis – flexes 5th toe

4th Layer of Intrinsic Muscles in Image J (5th panel –  horizontal)

  • dorsal interossei – abduct toes 2-4 (spreads toes)
  • plantar interossei – adduct toes 3-5 (returns toes to resting position)

Image K

Now, given that mess of muscles, you probably appreciate how complex foot movements can be achieved. With some 20 intrinsic and 10 extrinsic muscles controlling our feet, they are quite capable, indeed!

Back to Outlander! We see Claire’s poor, weary beat feet, exposed to sand, surf, sun and formicidae (Anatomy Lesson #55, Formidable Formicidae) in Outlander ep 311, Uncharted! Trudging in wet shoes, dealing with festering ant bites, surviving snake slithers…. Diana explains Claire’s feet in Voyager book:

Squads of tiny purple crabs ran off in profound agitation at my approach. My feet sank into the mud to the ankles, and I thought better of putting on my shoes, wet as they were… My feet were bruised and sore, and punctured by fallen palmetto fronds, but the path before us looked relatively smooth.

We really must take good care of our feet if we want them to last. Exercise, weight control, healthy diet, wearing supportive shoes all help ensure the feet bear our weight for a lifetime. Even to the most careful, our feet suffer many assaults: bone spurs, athlete’s foot, plantar fasciitis, corns, bunions, Morton’s neuroma, flat feet, hammer toe, warts, stress fractures, etc. Or, we lose toes because of poor circulation, trauma, or developmental issues –  such problems have plagued us since ancient times. To the point, the oldest known functional prosthesis is an Egyptian wooden mummy toe  (Image L). It actually articulates at the laced surfaces. So clever! 

Hey, wait! How do we know it is not a daddy toe? He, he!

Image L 

Speaking of toes, Voyager book describes a splendid battle with pirates aboard ship. Sadly, the scene did not make it into the TV version. But, here is a shocking tidbit from the bloody fight:

Cursing incoherently under my breath, I ran to the bottom of the ladder, and reaching up, swung the long-handled amputation knife at his foot, as hard as I could. There was a high-pitched screech from the pirate. Something flew past my head, and a spray of blood spattered across my cheek, wet-hot on my skin. Startled, I dropped back, looking down by reflex to see what had fallen. It was a small brown toe, calloused and black-nailed, smudged with dirt.

Alrightie then! <G>

Let’s consider how you can hurt your neat, sweet, elite, complete feet… In your wildest dreams, do you think shoes such as these are good for feet (Image M)? Wear high heels for long, and one guarantees that later in life, the wearer will have foot problems. The foot is not designed to walk around on the metatarsophalangeal joints (ball) of the foot, which is why wearing spikes hurt!!!

Gentle admonition: if you wear this type of footwear, you should stop.

Image M 

Closing this lesson with indiscrete feet: no Outlander lass is quite as indiscrete and raunchy as Geillis (Gillian) Edgars Duncan Abernathy. Puir young Ian; that dear lad’s cheek is no place for a witch’s foot (Outlander ep 313, The Bakra)! 

BTW, the prominent ridges passing to 2nd to 5th toes are tendons of extensor digitorum longus! Yay!

Bottom line: The complete and complex human foot is truly an anatomical work of art. Let’s vow to take good care of ours!

The deeply grateful,

Outlander Anatomist

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Photo Creds: Sony/Starz; www.cba.ca (Image – L); www.DHgate.com (Image M ); www.digikalla.info (Image J); www.earthslab.com (Image G); www.footankle.strker.com (Image C); www.goodfeet.com (Image A); www.heatheappointments.com (Image I); www.nurseslab.com  (Image K – ); www.slideplayer.com (Image E, Image F, Image H); www.teachmeanatomy.com (Image B); www.wickimedia.commons.org (Image D)

Anatomy Lesson #59: Claire the Knife!

“Claire the Knife” is not a usual anatomy lesson. Rather, let’s explore the many images of Claire with a honed edge either in her hands or directed at her person! Such images are taken from S1-S3 of Outlander. There are even more examples in Herself’s books that weren’t translated onto the screen. Please notify me if I miss any fine examples of “Claire the Knife!”  Let’s get started!

Early in Outlander episode 101, Sassenach, Claire accidentally encounters Frank’s ancestor, Captain Jonathan Wolverton Randall, Esq. From Outlander book:

“Who the bloody hell are you?” I demanded again. 

… He bowed sardonically, hand over his heart. “I am, madam, Jonathan Randall, Esquire, Captain of His Majesty’s Eighth Dragoons. At your service, madam.”

Not an officer-and-a-gentleman, she is soon backed against a stone ridge with his sword pressed to her lovely throat (Anatomy Lesson #12, Claire’s Neck or The Ivory Tower). 

Your honor, I submit, Exhibit #1! <g>

Then, in Outlander episode 104, The Gathering, Claire twice encounters a knife, once in her hand and once shoved into her beautiful face!

Swiftly gliding into Mrs. Fitz’s kitchen, Claire grabs for a butcher knife amid bins of potatoes (Hey, I thought Jenny introduces those to Scotland?), chicken and other delectables. She is gathering provisions for a furtive flight to the stones. Outlander book explains: 

During my hours helping in the kitchens and orchards, I had managed to stow away sufficient food to see me provided for several days, I thought… I had stout boots and a warm cloak, courtesy of Colum. I would have a decent horse; on my afternoon visit to the stables, I had marked out the one I meant to take.

Her knife grab is thwarted by Ms. Fitz: 

“Claire! You aren’t wearing that to the ceremony, are ye lass?”

No, Mrs. Fitz, she’s not wearing that butcher knife! Hee, hee.

Later in evening as the entire ensemble is either oath-taking or stinking drunk, Claire sidles into the stables to steal away on Brimstone.

Oops! She steps on Jamie cocooned in hay (yay!).  Mistaking her as a threat, he threatens her with his dirk! (wink, wink) 

“Jesus H. Rosevelt Christ!” 

“No, sassenach, just me.” 

(We all ken he is divine, just not that kind of divine!)

From Outlander book: 

The obstruction rolled over with a startled oath and grasped me hard by the arms. I found myself held against the length of a sizable male body, with someone’s breath tickling my ear.

Then, Dougal and his band of merry men head off to collect taxes and conduct other clan “business” in  Outlander episode 105, Rent.  Dougal explains in Outlander book:

“Through the MacKenzie lands. Colum doesna travel, so visiting the tenants and tacksmen that canna come to the Gathering—that’s left to me. And to take care of the bits of business here and there.”

On the road, Claire witnesses “fowl” play by Dougal and his men. Declaring she will not eat yummy-looking birds she thinks were roasted by thieves, Claire quickly faces the point of Angus’ dirk.  Angus is having none of it that kind of name calling, especially from an English sassenach spy! Fortunately, Jamie talks him down and Claire flounces away with left eye intact. 

By episode’s end, Claire and Dougal are accosted by Lt. Jeremy Foster.

In Outlander episode 106, The Garrison Commander, both are delivered to the garrison at Brockton.  There, she enjoys a sumptuous meal (excepting the claret) with Brigadier General Lord Oliver Thomas, et al, until, horror of horrors, Captain Black Jack arrives. Thereafter, things take a distinctly downward turn! 

After aiding the amputation of a soldier’s arm, she returns to the dining room to find puir Corporal Hawkins performing ablutions on BJR! Claire recognizes the stropped blade as a family heirloom – the very one she used to shave first hubby, Frank.

If only, she held that blade to BJR’s neck – could have saved she and Jamie a world of hurt! Another blade – another time. From Outlander book: 

“Yes, I thought so. It had to be you, from MacKenzie’s description.” The door closed behind me, and I was alone with Captain Jonathan Randall of His Majesty’s Eighth Dragoons. He was dressed this time in a clean red-and-fawn uniform, with a lace-trimmed stock and a neatly curled and powdered wig.

But the face was the same—Frank’s face. My breath caught in my throat.

This time, though, I noticed the small lines of ruthlessness around his mouth, and the touch of arrogance in the set of his shoulders. Still, he smiled affably enough, and invited me to sit down.

Escaping BJR’s clutches, Dougal stops off at St. Ninian’s spring for a wee nip of sulfurous water. Known in the highlands as a liar’s spring, he waits to see if the magical waters will burn Claire’s gullet (Anatomy Lesson #45, Tremendous Tube – GI System, Part 2)!  He draws a dirk to finish her off should massive heartburn set in. From Outlander book: 

“No!” Something occurred to me. “So at least you believe me when I say I’m not an English spy?”

“I do now.” He spoke with some emphasis. …

“St. Ninian’s spring.

…They call it the liar’s spring, as well. The water smells o’ the fumes of hell. Anyone who drinks the water and then tells untruth will ha’ the gizzard burnt out of him.”

Fast forward one episode, Dougal finally gets his wish as his dirk bites into Claire’s wrist!

Blood vow at a wedding she never sought, but well worth the scar!

Ye are Blood of my Blood, and Bone of my Bone. 

I give ye my Body, that we Two might be One.

I give ye my Spirit, ’til our Life shall be Done.

Outlander Episode 108, Both Sides Now: Still on rent-collection duty, the MacKenzie band is raided by Clan Grant! Rent, horses, food, what-have-you, everything is fair game. In the aftermath, Jamie is scolded for giving his wife a dirk for protection but not teaching her how to use one. Time for Claire to get a knife-life lesson. Ned Gowan extracts a small sgian dubh drawn from a more private part of his, ahem, breeks. So, she takes a knife-wielding lesson from TV Angus/book Rupert. Willie is the sacrificial lamb: 

He poked a blunt forefinger under the lower rib on the right, … “This is the spot in back—either side. See, wi’ all the ribs and such, ’tis verra difficult to hit anythin’ vital when ye stab in the back. If ye can slip the knife between the ribs, that’s one thing, but that’s harder to do than ye might think. But here, under the last rib, ye stab upward into the kidney. Get him straight up, and hell drop like a stone.” 

Fab advice as hours later, Jamie and Claire slip into the heather for a quick tryst, soon to be disturbed by two Redcoat deserters (coitus interruptus –  snort!). Thwarting her assaulter, Claire thrusts the sgian dubh – into the spot – as she was taught. The lass learned her lesson well!

Then, comes Outlander episode 109, The Reckoning: Captured by the Redcoats, assaulted (again) by BJR, rescued and then skelped by her second husband, they seek their way back to each other. As an act of penance, Jamie swears fealty to Claire, this time the dirk is pressed against his bosom (Outlander book):

I swear on the cross of my Lord Jesus, and by the holy iron which I hold, that I give ye my fealty and pledge ye my loyalty. If ever my hand is raised against you in rebellion or in anger, then I ask that this holy iron may pierce my heart.

And, they are off to the races! Oops – not so fast, my lad. In the midst of “reconciliation,” Claire threatens Jamie’s chin with his dirk (Anatomy Lesson #26, Jamie’s Chin – Manly Mentus).

“If,” I said through my teeth, “you ever raise a hand to me again, James Fraser, I’ll cut out your heart and fry it for breakfast!” 

Och! Parritch sounds much, much bettah!

Then, things quiet down for a bit and we see little of “Claire the Knife.” That is, until BJR gets his hands on Jamie. He has coveted the lad since the first flogging. After Murtagh scraps what is left of Jamie off the dungeon stones, they flee Wentworth, returning Jamie to his lawful wife.  There she mends his mangled hand, courtesy of BJR and giant Marley.

Blades again, this time in the form of scissors, clip sutures used to mend his broken skin (Outlander ep 116, To Ransom a Man’s Soul).

Up pops Season 2. Claire, being pregnant with Faith, isn’t into knife heroics.  An exception is her work at the Paris charity hospital, L’Hôpital des Anges. There, the scalpel blade slips nicely into her hands. Consider a workman’s festered wound due to an embedded splinter. She opens the wound and removes the offending object (Outlander episode 203, Useful Occupations and Deceptions). That knife has a life of its own!

Fast forward to Outlander episode 213, Dragonfly in Amber, wherein Jamie and Claire find themselves mired in a desperate struggle with Dougal – sly Uncle is intent on killing the sassenach witch!

He should have known that Jamie would protect her with name, clan and body!  But, neither reason, threat, nor cajoling stops Dougal’s advance. A blade to the chest is the only remedy  – in which Claire takes an equal hand – she finishes what Jamie cannot do alone!

Then, comes season 3. The next time a knife creeps into Claire’s hand, it is at the teaching theater awaiting her first anatomy class as a medical student (yay!). Arriving early, she feels the heft of the professor’s scalpel and is pleased with the heft; it fits well in her surgeon-to-be hand (Outlander episode 302, Surrender). 

Following the swiftest medical education ever, Claire is soon a practicing surgeon, clipping “necrotic” tissue from a patient’s abdomen (Outlander ep 305, Whisky and Freedom). Time and training has given Claire the license to legally cut another human. Such is her special calling and she fulfills it with grace and skill. Snip, snip. (Pssst… necrotic tissue isn’t pinkish-red in color, but don’t tell anyone.)

Next thing we know, Claire has donned a bat suit and gone back through the stones to seek A. Malcolm of Edinburgh (Outlander ep 307, Creme de Menthe). Confronting an exciseman in nothing but her shift and a hidden knife, Claire stabs his leg. Have knife – will travel!! He falls, striking his head on the hearth.  

Jamie arrives and what to his wondering eyes should appear, but a dying man – oh such is his fear!

Sassenach, what the devil happened????

I step away to do a little smuggling and return to find my wife with her knife and a dying man!!!

Still counting? Trying to save the life of the SOB (she’s a doctor!), Claire sends for a trephine from the local barber surgeon. She opens her medical kit, retrieving her trusty-not-rusty scalpel. Yes!

She makes a swift cut through the scalp – a space is opened through which the trepanning instrument is inserted. Then, she starts drilling for oil.  Not really, she drills to relieve pressure from an epidural bleed. 

Hang on, Snoopy, hang on – we’re almost finished! Then, in episode 308, First Wife, Claire uses her magic scalpel to open a nick near Jamie’s left oxter (Anatomy Lesson #4, Jamie’s Chest” or “the 8th Wonder of the World!). Her goal is to retrieve bits of lead discharged from Laoghaire’s fowling piece. She grasps and retrieve the bits leaving Jamie’s axillary/brachial artery intact (Anatomy Lesson #56: Achy Brachial Artery)! She is super good with a knife!  

The last time we see Claire wield a blade in TV Outlander, she confronts the Bakra (Outlander episode 313, Eye of the Storm)! Picking up a machete (ax in Voyager book), she screams and advances on Geillis Abernathy! She must prevent the witch from her fulfilling her plan to kill young Ian and pass through the time portal to slay Bree. 

Whack! Claire’s blade finds its mark and the wicked witch lies deid! Graphically explained in Voyager book:

Reflections of the fire burned red in the pupils of her eyes. The red thing, Jamie had called it. I gave myself to it, he had said. 

I didn’t need to give myself; it had taken me.

After fleeing Abandawe cave with Ian and Jamie, Claire trembles in the jungle with gore dropping from the machete. 

It is then she realizes, the 200+ y.o. bones she examined in Boston with Dr. Joe Abernathy (Outlander ep 305, Whisky and Freedom) belonged to none other than Geillis Abernathy!  And, Claire herself, ushered in that well-earned fate! Like I said, Claire the Knife!

To summarize, over many episodes, Claire is at one end or the other of a blade; always has been – always will be. <G>

Bobby Darren sang the hit, “Mack the Knife.” I re-imagine it as, “Claire the Knife:”

Oh, the shark, babe, has such teeth, dear

And it shows them pearly white

Just a jackknife is Miss Claire, babe

And she keeps it, ah, out of sight.

Dinna mess with the Sassenach Surgeon!

The deeply grateful,

Outlander Anatomist

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Photo Creds: Starz, Outlander episodes 101, 104, 105, 106, 107, 108, 109, 116, 203, 213, 302, 305, 307, 308, 313