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Bog spavin is recognized by the distended condition of the joint capsule which is prominent just below the internal tibial malleolus and this affection is characterized by a fluctuating swelling which varies considerably in size in different subjects.
As examples of proximal ligation for secondary hæmorrhage may be cited ligation of the hypogastric artery for hæmorrhage in the buttock, of the common iliac for hæmorrhage in the thigh, of the brachial in the upper arm for hæmorrhage from the deep palmar arch, and of the posterior tibial behind the medial malleolus for hæmorrhage from the sole of the foot.
In the British Museum there is a most instructive specimen of the leg-bones, showing that the fibula was represented by the external malleolus and by a flat tongue of bone, which extends up from it on the outer side of the tibia, and is closely ankylosed with the latter bone.
While the development of the collateral circulation after the ligation or obstruction from other cause of a main arterial trunk may be sufficient to prevent gangrene of the limb, it may be insufficient for its adequate nourishment; it may be cold, bluish in colour, and there may be necrosis of the skin over bony points; this is notably the case in the lower extremity after ligation of the femoral or popliteal artery, when patches of skin may die over the prominence of the heel, the balls of the toes, the projecting base of the fifth metatarsal and the external malleolus.
Livy mentions two remarkable and flagitious eras, of three thousand persons accused, and of one hundred and ninety noble matrons convicted, of the crime of poisoning. Hume discriminates the ages of private and public virtue. The first parricide at Rome was L. Ostius, after the Second Punic War. During the Cimbric, P. Malleolus was guilty of the first matricide.
Exposure of the plantar nerves by an incision behind the medial malleolus, and subjecting them to forcible stretching, has been employed by Chipault and others in the treatment of perforating ulcers of the foot.
In the British Museum there is a most instructive specimen of the leg-bones, showing that the fibula was represented by the external malleolus and by a flat tongue of bone, which extends up from it on the outer side of the tibia, and is closely ankylosed with the latter bone.
When gangrene occurs from such causes, it tends to be of the moist type. Much commoner is it to meet with localised areas of necrosis due to the excessive pressure of splints over bony prominences, such as the lateral malleolus, the medial condyle of the humerus, or femur, or over the dorsum of the foot.
Similarly the tibialis posterior may be displaced over the medial malleolus as a result of inversion of the foot. The long tendon of the biceps may be dislocated laterally or more frequently medially as a result of violent or repeated rotation movements of the arm, such as are performed in wringing clothes.
There is severe pain and considerable swelling on the lateral aspect of the ankle; the peroneus longus by itself, or together with the brevis, can be felt on the lateral aspect or in front of the lateral malleolus; the patient is unable to move the foot. By a little manipulation the tendons are replaced in their grooves, and are retained there by a series of strips of plaster.
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