Ankle

“ By educating ankle and foot to work alone we keep the hands in reserve for increasingly difficult passages. Often the ‘prop’ of a bent ankle above a side-foot hold gives us the second point of contact with the rock which is all that our balance requires. ”

“ The exciting cause, or that which called her attention to her foot, was the alleged slipping of the tendon of the peroneus longus muscle where it passes under the outer ankle-bone. She had no theory, fancy, or any other sentiment regarding her lameness whatever. She simply dropped her toes when walking, and was obliged to lift that limb very high to advance the foot and prevent stumbling. When, in examining her, I asked her to raise the foot, she was unable to do so. The muscles moving the ankle-joint were powerless. ”

“ A few rapid upward strokings with some force complete the treatment of the part, and the ankle is next dealt with. The joint is moved in every possible direction, slowly but firmly, the crevices between the articulating bones sought out and kneaded with the finger-tips, and the foot and ankle are then carefully covered. ”

“ Along with the effort a sharp pain darted through her ankle—so sharp and severe that she came near crying out, and after making a step or two forward, she sank, with a little moan, down on the ground again, clasping her spent ankle with both hands. ”

“ There is often considerable difficulty in distinguishing a sprain of the ankle from a fracture without displacement, as both forms of injury result from the same kinds of violence, and are rapidly followed by swelling and discoloration of the overlying soft parts. ”

“ It is generally occasioned by a fall, the foot or hand coming awkwardly to the ground, the muscles being at the time relaxed and unprepared; by over-exertion in lifting heavy weights; by entanglement and twisting of the limb, &c. The ankle is often sprained by what is called a false step; the fore part of the foot comes in contact with an obstacle unexpectedly, the foot is twisted under the limb, the weight of the body is thrown on the apparatus of one side of the joint, and this is in consequence immoderately and unnaturally stretched. ”

“ In the mastery of balance climbing the ankle plays a very important part. So that the body may progress smoothly when the feet are clinging only to small or very inclined holds, the ankle must be strong enough and supple enough to support the weight at rest or in motion, no matter at what angle it may be bent, forward or backward or sideways. The extent to which the ankle can be flexed varies with the individual. ”

“ Boots which button up the legs are not so liable as shoes to weaken the ankles, because they protect the latter, but with high-heeled shoes the ankle is left bare, and consequently every time that you twist your foot, you wrench the ankle-joint. We have seen serious disease of the ankle following repeated wrenching or spraining from wearing high-heeled shoes. The higher and narrower the heels are, the more liable are they to do harm. ”

“ If the ankles were to be used but a day or a week, such support might serve; but as no one intends to rely permanently upon such artificial support, and as any pressure checks the circulation and the development of the parts, so a lacing to the ankle, as a lacing about the chest, may feel comfortable and give a sense of support for the time being, but, in either case, will, in the long run, only produce absorption and weakness. The ankle joint should be left entirely without ligature, without any pressure, and by exercise be developed into a self-supporting institution. ”

“ If you had to keep your ankle still for a long time, say in a plaster cast, the bones would grow together, and doctors are very careful to see that joints are exercised just as soon as possible, in such cases. ”

“ The young man was on his knees beside her. "Permit me," and with gentle, sensitive fingers he gently removed the little shoe, and touched the the injured ankle, which was already feeling hot and swollen with pain. ”

“ In delicate, weakly persons, or in those who suffer from certain diseases of the vascular system, this is not the case; and after standing or walking for a long time the legs become swollen, so that the boots feel tight, and sometimes even a distinct impression may be remarked at that part of the ankle which was covered by the boot. ”

“ This joint is formed by a polished glass ball plying in a socket of vulcanite, the foot and ankle being joined together with four tendons, passing through rubber springs in the ankle; this joint admits of every motion the natural ankle has. In walking on the side of a hill or inclined plane, or where the foot is used to brace the body, the ankle flexes laterally and the foot remains flat on the ground, thus giving a firm base of support. ”

“ Weak ankles, often the result of the ungraceful, and, in other respects, pernicious fashion of wearing high, narrow-heeled shoes, straining them by their rolling about, etc., may be the exciting cause of lateral curvature of the spine. The weaker ankle is generally the left, and the individual soon forms the habit of standing on the right foot. ”

“ The shoulder, in order to allow of extensive movement, has no osseus or ligamentous strength; it is, therefore, frequently dislocated. The wrist and ankle are rarely dislocated; as the result of violence at the wrist the radius gives way, at the ankle the fibula, these bones being relatively weaker than the respective joints. ”

“ These ligatures are worn extremely tight, and result not in atrophy of the limb, as might be expected, [79] but in an enormous swelling of the muscles above or below them. The ankle ligatures sometimes reach half-way up the leg. ”

“ The first thing that strikes a person on looking at the human foot is its large proportion of bone. On pressing its top surface and that of its inner side, the amount of flesh will be found to be very small, indeed. The same is true of the inner and outer ankle. The extreme back of the ankle has scarcely any flesh covering. The most fleshy portions of the foot are its outer side, the base of the heel and the ball of the big toe. ”

“ On [Pg 167] steep slabs a very flexible ankle will often let the foot rest flat, getting an overlapping or friction hold on several rugosities of surface with its whole sole where a less practised ankle or a stiff-sided boot must trust to the less secure catch of a side-nail on one such roughness. Quiet movement is essential; to leave a slight hold hurriedly is as dangerous as to arrive on it clumsily. If you have to use a knee or hip or forearm as a friction hold, set it as gently and relieve it as lightly as if it were a single finger. ”

“ I knew a man who was struck in the ankle, and they had to amputate the leg, and the very bones of that leg were saturated with the blood that had seeped through the weakened walls of the blood vessels. ”

“ This lunge will do for every cut and every point.
To recover after a lunge, throw your weight well back upon your left leg, and use the muscles of the right thigh and calf to shoot yourself back into position. If the knee of the right leg has been kept exactly over the ankle, the impetus necessary to regain your original position will be easily obtained. If, however, the right foot has been protruded too far, and the caution as to the knee and ankle disregarded, you will find yourself unable to return quickly from the lunging position, and will consequently be at your opponent’s mercy. ”

“ At the ankle it affects the peronei, the extensor digitorum longus, or the tibialis anterior. It is most often met with in relation to the tendo-calcaneus--_Achillo-dynia_--and results from the pressure of ill-fitting boots or from the excessive use and strain of the tendon in cycling, walking, or dancing. There is pain in raising the heel from the ground, and creaking can be felt on palpation. ”

“ But for pure rock work their thickness should never be allowed to interfere with the sense of touch in the toes. Any constriction round the ankle, by the boot, or round the knee, by the breeches, is for the same reason to be avoided. To check the circulation or to cramp a sinew or muscle is to interrupt the telegraphic messages upon which balance and safety depend. ”

“ From one to two months are required to secure union in a broken leg in adults, and from three to five months elapse before the limb is completely serviceable. In children the time requisite for a cure is usually much shorter.
ANKLE-JOINT FRACTURE.
First Aid Rule.—One or both bones of leg may be broken just above ankle. Foot is generally pushed or bent outward. Prepare two pieces of thin wood, four inches wide and long enough to go from sole of foot to just below knee:—the splints. Pad them with folded towels or pieces of blanket. ”

“ On the contrary, if the leg is placed only slightly forward with but little flexion of the knee, as explained in the detailed description, the upper body has to be bent further downward in order that the hands reach the lower leg at the ankle. ”

“ The wasting of these muscles is of little importance to us who have no need to use our toes in detail; but it is far otherwise with the deep flexors of the foot and toes which are attached to the leg-bones, and whose tendons pass under the ankle joint and arch of the foot and form their chief support. It is, indeed, from the wasting or inaction of the deep flexor muscles, coupled with the turning out of the toes which fashion has imposed upon us, that the ankle and arch of the foot give way under the changed position of the limbs in girls at puberty, which I have described ”

“ Two classes seem to suffer frequently from sprained ankle—those with yielding arches and those with high insteps. Apparently there is weakness in the excess in both directions. Very flatfooted people apparently do not suffer so frequently from sprained ankles as those in whom there is only an incipient yielding of the arch. They seem to have learned to walk more circumspectly. Perhaps, too, their well-known tendency to toe outward lessens their liability to turning on their ankle. ”

“ If general treatment is necessary, then packing-sheets. Tepid bath and tepid sitting baths must be resorted to.
Sprained Ankle.—Put the foot immediately into cold water, and rub foot, ankle, and leg up to the knee for an hour, particularly the wounded part. The water of the bath, after the first time, only up to the instep, but repeated three or four times a day. Bandage the foot, ankle, and leg up to the knee; first, with quite wet bandages, and when inflammation has somewhat subsided, then with heating bandage. The foot should not be allowed to remain quiet. ”

“ There was a history of some slight injury, with periods of improvement during the first six months of her lameness, but with a final loss of ability to use it on account of its exceeding painfulness at every attempt to bear her weight upon it, and she had been for that length of time on crutches. The foot and ankle were very thin, cold, and clammy, and even very gentle manipulation caused considerable pain. ”

“ The lower portion of the spine is thrown to the left, and the dorsal portion necessarily thrown to the right.” In another place he repeats: “We find that almost without exception, in curvature to the right, the left ankle is much weaker than the other. ”

“ This was the direct result of his previous inaction. He moved only with pain; and yet, by the stern north-country code, he made no complaint and moved as rapidly as possible. Each time he raised his knee a sharp pain stabbed his groin, as though he had been stuck by a penknife; each time he bent his ankle in the recover the mal de raquette twisted his calves, and stretched his ankle tendons until he felt that his very feet were insecurely attached and would drop off. ”

“ THE LEG AND ANKLE.
115. Bony points.—The tubercle of the tibia (for the attachment of the ligamentum patellæ) , the sharp front edge called the shin, and the broad flat subcutaneous surface of the bone can be felt all the way down. The inner edge can be felt too, but not so plainly. The lower third is the narrowest part of the bone and the most frequent seat of fracture. ”

“ If the hands are allowed to pull the nose into the rock we are easily pounded. The protection is footwork and the flexible ankle. It is the business of the ankle to bend and stay bent at whatever angle may keep our body in safe balance and away from the rock, and to transmit our weight to the foot at just the right angle to hold it firm on its sloping stance. The farther out from the rock we can keep the weight, the steeper the apparent angle of foothold which it is safe to use. ”

“ The ankle- and elbow-joints suffer much less commonly than the knee. The effusion into the articulation takes place insidiously, although rapidly producing considerable enlargement of and fluctuation in the joint, without local heat, redness, or tenderness, and often with but little or no pain or pyrexia. ”

“ There may be a feeling of weight in the limb, and in the case of the knee and ankle the patient tires on walking and drags the leg with more or less of a limp. Movements of the joint are permitted, but are limited in range. ”

“ Grasp the right ankle by the right hand, and, standing on the left leg, bend it until the right knee touches the floor, then rise slowly to a standing position again. The left hand must be kept extended all the time and must touch nothing. ”

“ Those at the knee, for example, contribute more to the length of limb than do those at the hip or ankle, and they are also the last to unite. In the upper limb the more active epiphyses are at the shoulder and wrist, and these also are the last to unite. ”