THE FOOT. 581 



Excision of these joints may, and often does, give rise to a flail-like condition. 

 The affected toe is deprived of its support and becomes displaced. Sometimes it 

 gets beneath the adjoining toes and pain is caused by their superincumbent pressure. 

 In other cases the toe is squeezed up above the level of the adjoining ones and is 

 rubbed by the shoe above, causing painful corns. In either case the toe affected is a 

 source of misery and not infrequently may require to be amputated. For these 

 reasons excisions are seldom resorted to except in cases of hallux valgus. 



Amputation of the Toes. Amputation of the phalanges does not cause serious 

 disability, but the loss of the head of the first metatarsal bone seriously weakens the foot. 



FIG. 604. Amputation of a toe at the metatarsophalangeal joint, with lateral flaps, showing method of 



disarticulating. 



Amputation of the outer four toes at the metatarsophalangeal joint is a diffi- 

 cult operation because, unless one is well informed, it will be hard to strike the joint. 

 It should be sought about i cm. (f in.) behind the web on the dorsal aspect, and 

 if approached on the plantar aspect especial care is to be exercised not to go too 

 far back and search for it on the neck of the metatarsal bone (Fig. 604). As in the 

 hand so also in the foot when the proximal phalanx is bent the prominence (or 

 knuckle) is formed by the head of the proximal (metatarsal) bone. 



