Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
In persons suffering with this condition it will be regularly noticed
that the weight is thrown upon the ball of the foot, on the
metatarsophalangeal joints, either because of a weak foot, or because
of a tendency of the toes to turn up.
+Treatment.+ 1. Proper strapping to raise the arch and bring the ends of
the toes down.
2. A pad across the ball of the foot _behind_ the metatarsal heads,
also brings the toes down.
3. Recommend shoes, wide across the ball, with a higher or lower heel
than ordinary, as the case indicates.
+Hallux Valgus.+ The term _hallux valgus_ is applied to a deviation or
displacement of the great toe outward, toward the outer border of the
foot.
In normal feet, the line of the great toe when prolonged backward,
should pass through the centre of the heel. This relation in civilized
communities is seen only in the feet of infants. In adults it is
observable only in the bare-footed races.
+Cause.+ It is frequently associated with flat foot, gout and
rheumatism, but it is primarily due to the use of inappropriate
foot-gear. It is only considered pathologic when the deviation is more
than fifteen degrees.
+Pathology.+ The displacement outward (which reaches 30 to 40 degrees in
the average case and may reach 90 degrees) of the phalangeal part of
the great-toe joint, uncovers the inner part of the head of the
metartarsal bone, and here the cartilage degenerates, and the bone
becomes condensed at its outer part. The inner lateral ligament is
lengthened and thickened and the sesamoid bones become displaced
outward and are often thickened.
Under the skin, at the inner and prominent aspect of the foot, is to
be found a bursa, which is liable to inflammation under pressure, and
is known as a bunion. The inflammation in this sac may extend to the
joint and thus disintegrate it.
+Symptoms.+ The toe is displaced outward and a reddened and shiny
condition of the thickened skin exists over the inner prominence and
perhaps over the top of the toe joint. The great toe if seriously
displaced, must lie over or under the other toes, the former being the
more common position. In other cases the second toe may be crowded up
as a hammertoe. The joint is painful and the inner toes, being crowded
to the outer side of the foot, are the seat of corns and callosities.
Flat foot is frequently associated with this condition.
+Treatment.+ In mild cases, the stocking should be split to allow a
separate stall for the great toe, and broad toed boots should be worn.
If flat foot exists, a support should be supplied for its aid in
restoring the position of the great toe. In severe cases, nothing
short of an operation is likely to be of value. A toe-post may be worn
for a time in mild cases.
Amputation of the head of the metatarsal bone gives uniformly good
results.
The toe is straightened and flexible; ankylosis with this operation
does not occur.
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