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two portions -an anterior, triangular, with the base backwards and 
measuring 3 inches from front to back, and a posterior, circular, 
measuring 2 inches m diameter. 
X-ray photographs were kindly taken by Mr. C. Thurston Holland, 
radiographer to the Royal Infirmary, and these throw much light on 
the nature of the deformity and the probable mechanism of its 
production. In the skiagram taken from above, the great toe is seen 
to be in a valgoid position, the greater amount of dislocation being at 
the metatarso-phalangeal joint. This outward position is not more 
than that of the great toes of many European civilized women. The 
second and third toes show the same change at the metatarso¬ 
phalangeal articulations, whilst the interphalangeal joints are acutely 
flexed. In the fourth and fifth toes this flexion of the interphalangeal 
joints completely masks the fact that the first phalanges are pushed 
outwards from their metatarsal bones. 
The first impression, on looking at the side view, is that the 
posterior part of the os calcis is in line with the tibia instead of being 
at right angles to it. Indeed, a radiograph of the os calcis alone, 
when compared with that of a normal bone, explains approximately 
half of the extremely arched condition of the foot. The posterior 
half of the os calcis is set almost at right angles to the anterior half. 
How this alteration in the shape of the calcaneum has been brought 
about is open to question. There are two possible explanations, 
either of which may be sufficient. A consideration of the ossification 
of the bone and of the accompanying radiograph supports the view 
which I take, that the change is mainly in the soft, newly-formed 
portion of the os calcis which is in contact with the so-called 
epiphyseal line (a better term for whicli would be epiphyseal plane), 
or perhaps in the epiphyseal plane itself. The cartilaginous 
ca caneum at birth contains a small central nucleus of bone which 
u timately forms the main portion. At about the tenth year a speck 
o bone appears at the posterior end, and these bony formations meet 
e sixteenth year. According to my view, the pressure, which is as 
a matter of fact applied in an antero-posterior direction, has caused 
e epiphyseal end to slide, as it were, round the main body of the 
one until it occupies a position below instead of behind it. Against 
view it may be argued that the epiphysis forms a relatively small 
proportion of the bone, as evidenced by the thin flake of bone which 
