separately. The
_tuberosity of the navicular_ is sometimes torn away by violent
traction on the ligaments attached to it.

#Fractures of the metatarsals and phalanges# usually result from
direct violence, such as a crush of the foot, in which the soft parts
are severely damaged. The use of the Roentgen rays has shown, however,
that certain painful conditions in the foot following comparatively
slight injuries, such as kicking a stone, are due to a fracture of one
of the metatarsals or phalanges.

When simple, these injuries are often overlooked, on account of the
difficulty of eliciting the signs of fracture from the swelling which
accompanies them. They are best treated in a moulded splint.

Compound fractures are more common, and are to be treated on the same
principles as govern such injuries elsewhere.

_A fracture of the base of the fifth metatarsal_ has been described by
Sir Robert Jones. It is produced by the patient coming down forcibly
on the lateral edge of the foot while the foot is inverted and the
heel raised--as, for example, in dancing. There is a localised
swelling over the base of the fifth metatarsal, and pain when the
patient puts weight on the foot. There is no crepitus or deformity.
The fracture is readily recognised by the Roentgen rays. Massage and
movement are employed from the first.

DISLOCATIONS IN THE REGION OF THE ANKLE

#Dislocation of the Ankle-Joint.#--In describing dislocation of the
talus from the tibio-fibular socket, the varieties are named according
to the direction in which the foot passes--backward, forward,
medially, laterally, or upward.

All of them may be complete, but they are more frequently incomplete,
and are liable to be rendered compound, either from tearing of the
skin at the time of the injury, or by its sloughing later. Although as
a rule there is little difficulty in effecting reduction by
manipulation, these injuries are liable to be followed by stiffness
and impaired usefulness of the joint.

The _backward_ dislocation is the most common, and results from
extreme plantar flexion of the foot, as from a fall backwards while
the foot is fixed, wedging the talus between the tibia and fibula.
The collateral ligaments are torn, and one or both malleoli may be
broken, or the posterior part of the articular edge of the tibia
chipped off (Fig. 99).

[Illustration: FIG. 99.--Radiogram of Backward Dislocation of Ankle.

(Professor Chiene's case.)]

The foot a