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It is met with most frequently in the tendo-calcaneus in gouty and rheumatic subjects who have overstrained the tendon, especially during cold and damp weather. There is localised pain which is aggravated by walking, and the tendon is sensitive and swollen from a little above its insertion to its junction with the muscle. Gouty nodules may form in its substance.
As examples may be cited the rupture of the quadriceps extensor in attempting to regain the balance when falling backwards; of the gastrocnemius, plantaris, or tendo-calcaneus in jumping or dancing; of the adductors of the thigh in gripping a horse when it swerves "rider's sprain"; of the abdominal muscles in vomiting, and of the biceps in sudden movements of the arm.
The tendo-calcaneus is detached from the calcaneus, the bursa dissected out, and the tendon replaced. If there is a bony projection from the calcaneus, it should be shaved off with the chisel. The bursa that is sometimes met with on the under aspect of the calcaneus the subcalcanean bursa when inflamed, gives rise to pain and tenderness in the sole of the foot.
The affection is known as Achillo-bursitis. There is severe pain in the region of the insertion of the tendo-calcaneus, the movements at the ankle-joint are restricted, and the patient may be unable to walk. There is a tender swelling on either side of the tendon. When, in spite of palliative treatment, the affection persists or relapses, it is best to excise the bursa.
It also occurs as a result of excessive piano-playing, fencing, or rowing. At the ankle it affects the peronei, the extensor digitorum longus, or the tibialis anterior. It is most often met with in relation to the tendo-calcaneus Achillo-dynia and results from the pressure of ill-fitting boots or from the excessive use and strain of the tendon in cycling, walking, or dancing.
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