In the series of cases presented there was one point in common: tenderness. In three cases there was also pain under the heel and tenderness. It is my opinion that when an os calcis is severely crushed by a fall upon the heel, and the astragalus is driven down into it, widening the heel and lowering the external malleolus so that it impinges upon the fractured os-calcis, changing fibula from a stay of the ankle joint into a weight bearing bone, for which nature never intended it, pain is produced. At least, it has in all the cases that I have seen. The subject of subastragaloidarthrodesis has not been discussed in connection with these cases. I could not demonstrate any motion in this joint in any case of this series. In fact, an arthrodesis had been performed by the severe trauma and nature's effort to repair it. We are not discussing fresh fractures, but I do not think it would be amiss to emphasize the necessity of more careful consideration and treatment of these cases immediately after injury. If they were properly molded, as has been advised by Cotton and others, most of these cases would not have needed operative interference. It was the persistent pain and tenderness of the first case in this series that first started me upon this investigation. I wish to emphasize the necessity of allowing for drainage when operating on these cases, as there is considerable oozing of blood. There is also one other point that I wish to stress: it is very difficult to show by radiogram the tunnel after it is made in the os calcis. I insist upon the patient bearing weight upon his foot at an early date. This is a necessary extra precaution so that dense fibrous tissue may not form and impinge upon the external malleolus.
(C) 1924 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.