#Hallux Varus or Pigeon-toe# (Fig. 158).--In this deformity, which is extremely rare, the great toe deviates from the middle line of the foot; it occurs chiefly in children in conjunction with other deformities, and interferes with the wearing of boots. Treatment consists in straightening the toe and retaining it in position by a splint or plaster of Paris. The medial collateral ligament and the tendon of the abductor hallucis may require to be divided. [Illustration: FIG. 158.--Radiogram of Hallux Varus or Pigeon-toe.] #Hallux Rigidus and Hallux Flexus# (Fig. 159).--These terms indicate two stages of an affection of the metatarso-phalangeal joint of the great toe, first described by Davies Colley. In the earlier stage--_hallux rigidus_--the toe is stiff and incapable of being dorsiflexed, although plantar-flexion is, as a rule, but little restricted. When the joint, in addition to being stiff, is painful, sensitive, and swollen, the term _hallux dolorosus_ is applied. [Illustration: FIG. 159.--Hallux Rigidus and Flexus in a boy æt. 17. There is a suppurating corn over the head of the first metatarsal bone.] As the disease progresses, the toe is drawn towards the sole and becomes permanently flexed--_hallux flexus_--and any attempt at dorsiflexion is attended with pain. The condition is met with chiefly in adolescent males, is nearly always associated with flat-foot, and is then usually bilateral. The patient's gait, in addition to having the characteristic features associated with flat-foot, is peculiarly wooden and inelastic, as instead of rising on the balls of the toes with each step, he puts down and lifts the sole as if it were a rigid plate. The pain is increased by walking. The boot tends to become worn away at the point of the toes and at the posterior edge of the heel, and the usual crease across the dorsum is absent. On dissection it is found, especially in hallux flexus, that the inferior portions of the collateral ligaments are contracted, and that the cartilage of that part of the head of the metatarsal which is exposed on the dorsum is converted into fibrous tissue; there may also be other changes characteristic of arthritis deformans. Bony ankylosis has not been observed.