THE FOOT. 



579 



If the calf muscles are paralyzed the contraction of the tibialis anterior and tib- 

 ialis posterior pull up the arch and the contraction of the flexor brevis digitorum 

 pulls the pillars closer together, therefore the 

 heel descends, the arch ascends, and the plantar 

 ligaments contract. If the extensor muscles are 

 also paralyzed the toes drop and the anterior de- 

 formity is increased. 



The treatment of this condition is as yet 

 not entirely settled. The plantar fascia must 

 be divided and the pillars of the arch separated 

 and the arch depressed by forcible manual or 

 instrumental means. To retain the foot in its 

 corrected position the tendo calcaneus is some- 

 times shortened and even the tibialis anterior 

 and posterior and peroneal muscles transplanted 

 anteriorly into the extensor "longus digitorum 

 so as to increase the power of dorsal flexion 

 of the anterior pillars of the tarsal arch. At 

 times some of these tendons are grafted on the 

 tendo calcaneus in order to pull the heel up. 

 Operations on the bones and joints are also per- 

 formed. 



Hallux valgus is a subluxation of the big 

 toe outward. There is usually a deformity of 

 the bone, the joint surface of the head of the 

 first metatarsal being inclined obliquely out. As 

 the toe becomes displaced outward the extensor 

 hallucis longus by its contraction tends to in- 

 crease the deformity. On the side of the head 

 of the protruding metatarsal bone a bursa de- 

 velops and becomes painful, forming a bunion. 

 This bursa sometimes suppurates (Fig. 601). 



In some cases hallux valgus is due ap- 

 parently to ill-shaped shoes, but in many cases, 

 and these the worst, a rheumatic-gouty condition 

 is the main factor. In treatment the articular 

 surface of the head of the first metatarsal bone is 

 first resected. This enables the toe to be brought FlG - 6o1 - Hal!ux 7f! gu showin g the position 



. , ~ . . -11 i r i * t" 16 bones. 



straight. I o keep it straight the tendon of the 



extensor hailucis is displaced inward so that by its contraction it keeps the toe from 



again going outward. 



THE TOES. 







The toes are shorter than the fingers and are not so often injured. When 

 injured or diseased healing may be delayed by the constant motion to which they 

 are subjected. For this reason rest should be enforced in obstinate cases by the 

 application of bandages or splints. 



Ingrown Nail. This usually affects the big toe. It is caused commonly by 

 the irritation and pressure of badly-shaped shoes. To cure it the side of the nail 

 is sometimes removed. In so doing the nail should be removed well beyond the 

 skin margin at the matrix otherwise it is reproduced in a distorted form. It requires 

 several months for a new nail to grow out from the matrix. Packing cotton soaked 

 in a solution of nitrate of silver, 10 grains to the ounce, beneath the edge of the nail 

 destroys the infection, lessens the pressure, and usually relieves the acute trouble in a 

 few days. 



Hammer Toe. This is a contraction of one of the toes, most often the second. 

 The deformity is usually consecutive to the use of badly fitting shoes. Walsham 

 (" Deformities of the Human Foot"), Shattock, and Anderson believe it to depend 



