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Exceptions to this last indication are to be found chiefly in women in whom the developments of the body are proportionally much greater, either from a temporary or a permanent cause, than those of the limbs, the muscles of which are consequently incapable of receiving the weight of the body by maintaining the extension of the ankle-joint.
A smart knock on the ankle-joint from the splinter of a shell that burst in my face, in itself a mere bagatelle of a wound, had been of necessity neglected under the pressing and incessant calls upon me, and had grown worse and worse till the whole foot below the ankle became a black mass and seemed to threaten mortification.
"The foot is there that is the amazing part of it and, as far as I can see, is well formed and of the normal size; but so embedded in the stump that I cannot discover whether the ankle-joint and bones of the lower leg exist in a contracted form or not." Ormiston poured himself out a glass of port. His hand shook so that the lip of the decanter chattered against the lip of the glass.
Beach speaks of an individual who suffered fracture of both thighs, and compound comminuted fracture of the tibia, fibula, and tarsal bones into the ankle-joint, necessitating amputation of the leg. The patient not only survived the operation, but recovered with good union in both thighs.
The Indian never flinched or groaned, although the pain must have been very great while the operation was being performed. Mr. Hardy then carefully bandaged the limb, and directed that cold water should be poured over it from time to time, to allay the inflammation. Another of the Indians had his ankle-joint broken: this was also carefully bandaged.
Mr. Neal's malady, however serious it might be in his own estimation, was of no extraordinary importance in a medical point of view. He was suffering from a rheumatic affection of the ankle-joint. The necessary questions were asked and answered and the necessary baths were prescribed.
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.
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