58o 



APPLIED ANATOMY. 



on a contraction of the plantar fibres of the lateral ligaments and glenoid ligament on 

 the under side of the joint. Others hold it to be a contraction of the tendons. In 

 treatment both conditions have to be considered. On pulling the toes the extensor 

 tendon is put on the stretch, it should be divided, the remaining contractures are 

 then either cut or broken by forcible stretching and the toe kept straight by band- 



FIG. 602. Hammer-toe. (From author's sketch.) 



aging until all tendency to contraction has been corrected. As a last resort resection 

 of the joint is performed (Fig. 602). 



Luxation of the Toes. The big toe may become dislocated by direct vio- 

 lence; the lesion is often compound. The displacement is most often backward on 

 the dorsum of the metatarsal bone. When the injury is not compound the same dif- 

 ficulty may be experienced in reducing it as occurs in dislocation of the thumb. The 

 cause is the same. The head of the metatarsal bone becomes caught in the fibrous 

 tissues of the capsule and between the two 

 heads of the flexor brevis hallucis muscle. 

 These each contain a sesamoid bone. The 

 detachment of one of these heads from the 

 base of the first phalanx may be necessary 

 before replacement can be effected. 



Dislocation of the other individual toes 

 is not nearly so rare as it is thought to be. 

 It results from jumping from a height and 

 landing, perhaps on an uneven surface, with 

 the toes. The proximal phalanx may be 

 displaced upon the metatarsal bone and the 

 resulting pain is often considered to be merely 

 a sprain. 



The head of the affected metatarsal bone 

 can be felt projecting in the sole, the toe is 

 shortened and the space between it and the 

 adjacent one usually increased; but the diag- 

 nosis is difficult and is best established by 

 means of a skiagraph. Reduction is difficult 

 and even when accomplished is not apt to re- 

 main (Fig. 603). Resection may be required. 



Metatarsalgia or Morton's Disease. 

 This is a painful affection of one of the meta- 

 tarsophalangeal joints, usually the fourth. Its 

 pathology is not settled, but treatment is based 

 on the supposition that the heads of the metatarsal bones become pressed together, 

 usually by tight shoes. Relief is often afforded by separating the toes with cotton ; 

 by winding adhesive plaster several thicknesses around the affected toe; by sup- 

 porting the arch by pads or plates; by inserting a narrow longitudinal pad; or by 

 resection or amputation. 



Resection of the Metatarsophalangeal Joint. In hallux valgus resection 

 of the head of the metatarsal bone may give rise to a stiff joint. If the ankylosis is 

 in a somewhat extended position, walking may not be impaired. 



FIG. 603. Dorsal luxation of the proximal 

 phalanx of the second toe. Notice the shorten- 

 ing of the toe, its separation from the third toe. 

 and the fulness over the head of the metatarsal 

 bone. (From a sketch by the author.) 



