In the early stages, treatment consists in limiting the movements of extension by means of a splint provided with a hinge that locks at thirty degrees from full extension and vigorous massage of the quadriceps. In the dry, creaking forms of arthritis, the symptoms are relieved by introducing liquid vaseline into the joint. When the symptoms are due to the presence of fringes and loose bodies, these may be removed by operation. When the disease is of a severe type, and is confined to one knee, the question of excising the joint may be considered.
Bleeder's knee, Charcot's disease, hysterical knee, and loose bodies in the joint have already been described.
The Ankle-Joint
There is a common synovial cavity for the ankle and the inferior tibio-fibular joints. The epiphysial cartilage of the tibia lies above the level of this synovial cavity, but that of the fibula is included within its limits ([Fig. 93]). The talus is related to three articulations—the ankle above, the talo-navicular joint in front, and the calcaneo-taloid joint below. The tendon sheaths, especially those of the peronei and of the tibialis posterior, are liable to be infected by the spread of infective disease from the joint.
Tuberculous Disease.—Tuberculous disease at the ankle is met with at all ages. In the majority of cases the disease affects both bone and synovial membrane. Gross lesions in the bones are comparatively rare, and are chiefly met with in the head or neck of the talus.
Primary synovial disease usually exhibits the features of white swelling, projecting beneath the extensor tendons on the dorsum, and, posteriorly, filling up the hollows on either side of the tendo Achillis and below the malleoli ([Fig. 126]). The foot may retain its normal attitude, or the toes may be pointed and adducted. The calf muscles are wasted, there is little complaint of pain, and the movements of the joint may be so little interfered with that the patient can walk without a limp. When the disease involves the articular surfaces, there is pain and sensitiveness, the movements are restricted or abolished, and the patient is unable to put the foot on the ground.
Fig. 126.—Tuberculous Disease in a man æt. 35, of six weeks' duration.
A primary focus in the bone causes localised pain and tenderness, and a limp in walking, but the first sign may be the formation of abscess or the rapid development of articular symptoms. In such cases skiagrams afford valuable information.