ppears shortened, the heel is unduly prominent behind, and
the lower ends of the tibia and fibula project in front, sometimes
coming through the skin. The tendons around the joint are stretched or
torn.

_Forward_ dislocation results from extreme dorsal flexion at the
ankle-joint. The foot appears lengthened, the heel is less prominent
than normal, and the hollows on each side of the tendo Achillis are
obliterated. The talus is felt in front of the tibia, and the malleoli
appear to be displaced backwards and to lie nearer the sole.

_Medial_ or _lateral_ dislocation is only possible after fracture of
one or both malleoli, and may be looked upon as a complication of
these injuries.

In cases in which the interosseous ligament is ruptured, and in severe
cases of Dupuytren's fracture, the talus may be driven _upwards_
between the bones of the leg. There is great broadening in the region
of the ankle, and the malleoli are unduly prominent under the skin,
which is tightly stretched over them. They are also nearer to the sole
than normally. The movements of the ankle-joint are lost.

Dislocation of the _inferior tibio-fibular joint_ is exceedingly rare,
except in association with fractures of the lower ends of the bones of
the leg, particularly Dupuytren's fracture, or with dislocation of the
ankle-joint proper.

_Treatment of Dislocation of Ankle._--The patient having been
anaesthetised, the foot is extended and the knee and hip joints flexed
to relax the calf muscles as completely as possible. Traction is then
made upon the foot, while counter-extension is applied to the leg, and
the bones are manipulated into position. Reduction usually takes place
gradually without the characteristic snap which accompanies reduction
of most dislocations. It is sometimes necessary to divide the tendo
Achillis, particularly in cases of forward dislocation.

When the talus passes upwards between the tibia and fibula, it is
sometimes impossible to effect reduction by manipulation, and the best
results are then obtained by operation.

The after-treatment consists in keeping the leg on a pillow between
sand-bags, and carrying out the usual massage and movement.

In compound dislocations which have become infected, primary
amputation may be indicated, but in young and healthy subjects an
attempt may be made to save the foot.

#Dislocation of the talus# from its articulations with the bones of
the leg above and the calcaneus and navicu