Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
_Treatment._--Great improvement usually results from treating
coexisting flat-foot, and pain is relieved by rest, massage, and
douching. A tight bandage or strip of plaster applied round the
instep before putting on the stocking may relieve pain. Boots should
be made from a plaster cast of the foot, high and narrow at the instep
so as to compress the bases of the metatarsals, and with the medial
edge of the sole and heel slightly raised; a support may be worn in
the sole, like that used for flat-foot, with both the longitudinal and
transverse arches exaggerated. Scholl has devised a support for the
anterior arch which we have used with benefit. When the head of one of
the metatarsals is displaced, it may be removed through a dorsal
incision running parallel with the tendon of the long extensor.
#Hallux Valgus and Bunion.#--_Hallux valgus_ is that deformity in
which the great toe deviates towards the middle line of the foot and
comes to lie on the top of, or beneath, the second toe (Figs. 155,
157). The head of the first metatarsal projects on the medial border
of the foot, and, as a result of the pressure of the boot, an
adventitious bursa is formed, which, when thickened by chronic
inflammation, constitutes a prominent swelling or _bunion_. It is a
common affection in civilised and especially in urban communities, and
reaches its acme of development in adult women. It may occur on one or
on both sides, and is sometimes associated with flat-foot.
[Illustration: FIG. 157.--Radiogram of Hallux Valgus. The sesamoid
bone is seen displaced towards middle line of the foot.]
The deformity develops slowly, and is usually attributed to the
wearing of stockings which are unduly tight at the toes, and of
improperly made boots. The boot that favours the occurrence of hallux
valgus is one which is too short and has pointed toes, with the apex
in the middle line of the foot instead of being in line with the great
toe. The pressure of the boot displaces the great toe into the valgus
position, especially if a high heel is worn, as the toes are then
driven forward into the apex of the boot. Once the great toe is
abducted by the pressure of the boot, the deformity is increased by
bearing unduly on the medial side of the ball of the great toe, and by
pointing the foot outwards in walking.
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