A treatise on orthopedic surgery . en mistaken for sprain or rheumatism. In someinstances-they appear to follow an injury, but in the majority ofcases in childhood no cause can be assigned. The ankle becomessensitive to sudden movements; the patient limps, and there iscomplaint of discomfort after overuse and of pain at night. Thelimp differs in character from that caused by hip or knee patient walks with the limb rotated outward, bearing theweight upon the heel and upon the inner border, active leverage spring being 466 OBTHOPEDIC SUBGEBY. Primarily the symptoms are tho
A treatise on orthopedic surgery . en mistaken for sprain or rheumatism. In someinstances-they appear to follow an injury, but in the majority ofcases in childhood no cause can be assigned. The ankle becomessensitive to sudden movements; the patient limps, and there iscomplaint of discomfort after overuse and of pain at night. Thelimp differs in character from that caused by hip or knee patient walks with the limb rotated outward, bearing theweight upon the heel and upon the inner border, active leverage spring being 466 OBTHOPEDIC SUBGEBY. Primarily the symptoms are those of a persistent, somewhatpainful disability at the ankle, causing stiffness, limp, and attimes pain; later deformity appears. Deformity.—The primary deformity of ankle-joint disease inthe subacute cases is valgus, induced by a persistence of thepassive attitude. In more advanced cases it becomes equino-valgTis, and when the limb is no longer capable of supportingweight, but is held pendent, the equinus predominates. Fig. Tuberculous disease of the ankle. The joint is usually^ somewhat enlarged. In some instancesthe swelling is uniform; in others it is localized in front orbehind one of the malleoli. This swelling is not, as a rule,like that of simple effusion into the joint, but the tissueshave the peculiar elasticity characteristic of thickening and in-filtration. There is usually a perceptible increase in the localtemperature, and pressure directly upon the malleoli causes dis-comfort. The voluntary movements of the joint are restricted,and passive movements show the characteristic reflex muscularspasm, limiting both dorsal and plantar flexion. DISEASES AND INJURIES OF THE ANKLE-JOINT. 467 Subastragaloid —If the astragalus is primarily dis-eased, the symptoms are usually first apparent in the ankle-joint,but in certain cases the joint between the astragalus and the oscalcis is first involved. Disease at the subastragaloid joint isusually classed as ankle
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