REGION OF THE ANKLE. 



555 



Distention of the Joint. Fluid tends to find exit from the joint first ante- 

 riorly under the extensor tendons, next it tends to exude posteriorly and makes its 

 appearance as a swelling on each side of the tendo calcaneus (Achillis). The ankle- 

 joint is a comparatively tight one and in acute inflammations holds but little effusion. 

 When injected it assumes the position of a right angle and flexion does not occur as 



Groove for flexor longus 

 hallucis 



Internal lateral ligament 

 Anterior tibial tendon 



/ Posterior tibial 

 Groove for posterior 

 tibial tendon on the 

 inferior calcaneo- 

 scaphoid ligament 



Sustentaculum tali' 



Groove for flexor longus digitorum 

 FIG. 569. View of inner side of ankle-joint, showing the internal lateral ligament. 



in other joints (Fig. 571). The rounded appearance of the ankle in tuberculous 

 and other affections is not due so much to effusion within the joint as to inflam- 

 matory and tuberculous exudate in the tissues around the joint. 



Tuberculosis of the Ankle. This most often affects the body of the astrag- 

 alus. Sometimes the disease is located in the lower end of the tibia. In the former 



Anterior fasciculus of external 

 lateral ligament 



Astragalocalcaneal ligament 



Anterior tibiofibular 

 ligament 



Posterior (transverse) tibio- 

 fibular ligament 



Posterior fasciculus of 

 external lateral ligament 

 Middle fasciculus of 

 external lateral ligament 



Interosseous ligament 

 FIG. 570. Ligaments of the outer side of the ankle. 



case other of the tarsal bones are also frequently involved. In the latter an extra- 

 articular operation on the tibia above the internal malleolus may cure the disease, 

 but the motion in the joint often remains impaired. 



Excision of the Ankle. Formal resections of the ankle are rarely performed. 

 The joint is difficult to expose without extensive division of the tendons and other 



