. A practical treatise on fractures and dislocations. >. ^ See also Cabot and Binnev : Annals of .lanuavy, li»07. p. TA. 460 FRACTURES. leoli, especially of the internal one, pain, and loss of function. Crepi-tus is either absent or obscure; abnormal mobility may be recognizedby moving the posterior portion laterally. Pain is caused by directpressure and by a vo],untary effort to make plantar flexion againstresistance at the toes. The tendo Achillis feels less tense when pressedupon, and the depression on each side of it is obliterated by deformity of the heel is best re
. A practical treatise on fractures and dislocations. >. ^ See also Cabot and Binnev : Annals of .lanuavy, li»07. p. TA. 460 FRACTURES. leoli, especially of the internal one, pain, and loss of function. Crepi-tus is either absent or obscure; abnormal mobility may be recognizedby moving the posterior portion laterally. Pain is caused by directpressure and by a vo],untary effort to make plantar flexion againstresistance at the toes. The tendo Achillis feels less tense when pressedupon, and the depression on each side of it is obliterated by deformity of the heel is best recognized when com])ared with itsfellow from behind while the patient is kneeling. Treatment. The treatment is immobilization, preferably with mas-sage, for about three weeks; then passive motion, to be continued untilthe end of the second month. Cabot and Binney suggest the possibleadvisability in fractures with a large heel fragment of over-correcting Ftg. Fracture of os calcis. (Cabot.) the displacement by drawing the heel downward and forward. Cottonand ^Yilson ^ did this by passing a stout steel pin across in front ofthe insertion of the tendo Achillis and forcing the posterior fragmentforward and downward; they avoid recurrence of the displacement byfixing the foot in plantar flexion so as to relax the muscles of the ^ passed a strong elevator transversely through the foot closebeneath the fragments and forced them upw^ard, and then fixed themin place with a long nail driven through them from the back of theheel. When the direction of the violence with reference to the axis of theleg is such that the foot is adducted or inverted by it, the strain isbrought upon the external lateral ligament and the sustentaculum tali, 1 Cotton and Wilson: Boston Med. and Surg. Jour., Oct. 29, 1908.» Becker: Ztlblatt. fiir Chir., 1908, p. 112. FRACTURES OF THE BONES OF THE FOOT. Fig. 340. 461
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