[Illustration: FIG. 117.--Gouty Disease of Bursae in a tailor. The bursal
tumours were almost entirely composed of urate of soda. (Cf. Fig. 114.)]
An adventitious bursa may form over the _lateral malleolus_, especially
in tailors, giving rise to the condition known as "tailor's ankle"
(Fig. 117).
The bursa _between the tendo-calcaneus (Achillis) and the upper part of
the calcaneus_ may become inflamed--especially as a result of
post-scarlatinal rheumatism or gonorrhoea. The affection is known as
Achillo-bursitis. There is severe pain in the region of the insertion of
the tendo-calcaneus, the movements at the ankle-joint are restricted,
and the patient may be unable to walk. There is a tender swelling on
either side of the tendon. When, in spite of palliative treatment, the
affection persists or relapses, it is best to excise the bursa. The
tendo-calcaneus is detached from the calcaneus, the bursa dissected out,
and the tendon replaced. If there is a bony projection from the
calcaneus, it should be shaved off with the chisel.
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