DYSTROPHIES 



2243 



skin of the little toe is more likely to occur in negroes, who often 

 are fiat-footed. It is more common in males than in females, in 

 adults than in children, and, though it can apparently be found at 

 any age, is most common between thirty to thirty-five years. 



We are inclined to believe that the condition is of parasitic origin, the 

 infection taking place probably through the small superficial lesions or 

 wounds which may be found in people going barefooted. 



Pathology. — The constant irritation causes the epithelium to 

 proliferate internally and depress the skin, and cause the fibrous 

 tissue of the cutis to proliferate. There is also an endarteritis, by 

 which the blood-supply is gradually cut off the distal portion of 

 the toe, which therefore becomes oedematous and fatty, while the 

 bone undergoes rarefying osteitis, so that the digit is gradually 

 separated from the foot, a process which takes place through the 

 bone of a phalanx. The histological examination at the line of the 

 furrow shows proliferation of the epidermis, which projects down- 

 wards into the cutis, in which the connective tissue is increased in 

 quantity. The vessels show endarteritis and periarteritis; the 

 sweat-glands show proliferation and fatty degeneration of the cells. 

 The bone is in a condition of rarefying osteitis. 



Distally to the furrow the joints are effaced; the tissues show 

 fatty degeneration and oedematous infiltration. No organisms can 

 be found. 



Symptomatology. — The disease is purely local, and is not, in our 

 experience, attended by any general symptoms. It begins, as a 

 rule, as a furrow on the inner side of the digito-plantar furrow, 

 which slowly deepens and extends laterally and dorsally until the 

 two wings meet on the dorsum of the toe. While this is proceeding 

 the distal portion of the toe becomes swollen, and may appear as a 

 small globule surrounded posteriorly by a deep groove, by which it 

 is separated from the rest of the foot. Often an ulcer forms on the 

 inner side of the groove, and may cause much pain. 



Left to itself, the disease will last from two to ten years, though 

 cases have been reported of fifteen to fifty years' duration; but 

 eventually the toe drops off, or is knocked off, or is removed. The 

 process may, however, begin again in the stump. 



Usually the fifth toe is affected, but in about lo per cent, of cases 

 the fourth toe may be affected, and much more rarely the second 

 or the hallux. There are reports of the affection occurring also in 

 the fingers. 



Diagnosis. — The diagnosis affords no difficulty, the presence of 

 the constricting furrow being typical. It is easily differentiated 

 from leprotic lesions of the toes by the sensibility being normal 

 and by the absence of signs of leprosy in other parts of the body. 



The history makes the diagnosis clear between true ainhum and a 

 peculiar congenital ring -like constriction of the toes described by 

 some authors. This condition is present at birth, and its course 

 is, not progressive. 



