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The general shape of the bone closely resembles that of a normal one a marked contrast to its wasted condition and tapering extremity in paralytic calcaneus. Extension and flexion at the ankle are only limited by the shortness of the ligaments; there is no opposition from the conformation of the bones.
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 multiple variety of osteoma is considered with the diseases of bone. The bony outgrowth from the terminal phalanx of the great toe known as the subungual exostosis is described and figured on p. 404. Bony projections or "spurs" sometimes occur on the under surface of the calcaneus, and, projecting downwards and forwards from the greater process, cause pain on putting the heel to the ground.
If an exact diagnosis is made at an early stage of the disease and this is often possible with the aid of X-rays the affected bone is excised sub-periosteally or its interior is cleared out with the sharp spoon and gouge, the latter procedure being preferred in the case of the calcaneus to conserve the stability of the heel.
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