Sprained ankle is generally the result of violent excessive inversion, and comparatively seldom the result of violent eversion. It is worth while to consider in which joint the excessive movement takes place, for example in inversion. A great many doctors answer at once, and with assurance, in the ankle (talo-crural) joint. From the above many would be inclined to think, first of all, of both the lower joints of the foot, especially the posterior talo-calcaneal joint, since it is essentially in these joints that the normal, rather limited, movement of inversion takes place. Though inversion in the usual position in which a sprain occurs does not take place at the ankle, it does not follow that this joint may not be severely strained; we often find sprains even of the lateral ligaments of the knee. The fact that it is so usual for the ligaments on the outer side between the fibula and os calcis to be torn gives us no clue; they would be stretched whether the sprain occurred at the ankle or at both the joints between the os calcis and the astragalus. That the anterior talo-fibular ligament is so often torn points decidedly to a sprain in the true ankle joint. The short calcaneo-talar ligament in front of the sinus tarsi also sometimes gives the impression of being stretched or torn. A thorough examination often shows that both the ankle and posterior lower foot joints are injured, in other cases the anterior one is tender; nor is it uncommon also to find both the joints forming Chopart's joint very tender on pressure. The greater part of the inflammatory products due to excessive inversion are found in front and on the inner side of the external malleolus. Partial fracture (fissure) is found occasionally; * complete fracture less often.

Sprained ankle is the injury which in our day has been of most assistance in leading the general public to believe in massage, owing to its speedy and assured results and its lessening the unnecessary use of tight bandages. At the same time it was this injury which settled, in favour of rest, the old dispute as to whether movements ought or ought not to be allowed in acute joint affections.

In the middle of the nineteenth century the treatment of a sprained ankle consisted in keeping the foot raised and at rest, the use of ice-bags and more or less tight bandages, the latter often being continued for many weeks until all pain had vanished from the joint. This treatment lasted on an average about a month, and not uncommonly occasioned long continued functional disturbances.

The modern treatment, which takes about one-third of the time of the old treatment, and which gives better results, consists in keeping the foot raised and at rest, ice-bags during the most acute stages of the inflammation, and effleurage, given preferably twice a day for the first few days after the trauma, during the acute reaction. This manipulation is continued until recovery is complete, frictions being added by degrees as absorption goes on. All parts which a thorough examination of the joints referred to above shows to be inflamed owing to the sprain are treated by massage.

* I expect some of my readers are astonished at my lengthy description of a sprained ankle. This is, however, one of those everyday occurrences which are so common that they are little studied. It is worth while studying the subject thoroughly.

In most cases friction should be given chiefly above the sinus tarsi on the inner side and in front of the external malleolus. Bandages of all kinds are excluded.

In somewhat severe cases, which are those which most often come under a doctor's care, the treatment is begun immediately after the trauma, seldom lasts longer than fourteen days, but is longer in proportion to the time which has elapsed between the trauma and the beginning of the treatment.

According to the treatment by Swedish surgeons of ordinary fracture of the fibula immediately above the external malleolus, the limb is first fixed for fourteen days in plaster of Paris, and during the following week the patient, with his limb still in plaster, is allowed to be up and to use his foot. The object of this treatment is to assure healing and to maintain the normal position of the foot. The method of Mezger's school was to use only a bandage, without massage, and to allow the patient to walk about a few days after the trauma. This treatment was recommended in Sweden about 1870, but has rightly been abandoned, as it was not successful in preventing the position of eversion and abduction, in other words, the essential changes in flat-foot, threatened after these fractures.