AMPUTATIONS OF LOWER EXTREMITY.--Commencing with the most distal, and gradually working our way upwards, we find that partial amputations of the toes are extremely rare. Only in the case of the great toe is such an operation _ever_ admissible, for the other toes are so short, and the stumps left by amputation are at once so useless from their shortness, and so detrimental from the manner in which they project upwards and rub against the shoe, that any injury requiring partial amputation of a lesser toe is treated by its complete removal. [Illustration: FIG. V.] AMPUTATION OF DISTAL PHALANX OF GREAT TOE.--This is comparatively rarely required now. It used to be thought necessary for the cure of those not uncommon cases of exostosis of the distal phalanx, but it is now found that most of these can be cured by simply clipping off the exostosis. When necessary, however, and when the choice of flaps is possible, the best plan is by a long flap from the plantar surface (Fig. V. 4), as in the similar operation on the thumb; laying the edge of the knife over the dorsal aspect of the joint, cutting through it, and turning the edge of the knife round close to the bone, so as to cut out a large flap from the ball of the toe. AMPUTATION OF A SINGLE LESSER TOE--_second_, _third_, _or fourth_.--This operation is on exactly the same principle as that described for the corresponding finger; but it must be remembered that the metatarso-phalangeal joint is more deeply situated in the soft parts than is the metacarpo-phalangeal; and thus the commencement of the elliptical incision which is to surround the base of the toe must be proportionally higher up (Fig. V. 1). On the other hand, as it is very important to avoid as much as possible any cicatrix in the sole of the foot, the plantar end of the incision need not be carried to a point exactly opposite the one from which it set out, but it will be sufficient if it reaches the groove between the toe and sole. A little more care may thus be required in dissecting out the head of the first phalanx, but this is quite repaid by the cicatrix in the sole being avoided. Early division of flexor tendons renders disarticulation easy. AMPUTATION OF THE FIRST AND FIFTH TOES.--The incisions are conducted on the same principle as in the other operations, the operator being careful to preserve as much as possible (Fig. V. 2) of the hard useful pad of the inner and outer sides respectively. Most surgeons are now agreed that in these toes it is best not to remove the head of the metatarsal bone with the toe. Cutting off the large cartilaginous head obliquely with a pair of bone-pliers may prevent an awkward unseemly projection, but it does diminish the strength of the transverse arch of the foot.