The patient, a gardener, aged fifty-seven, was admitted to St.
Thomas’s Hospital in May last with contraction of both hands.
He stated that he first noticed a slight contraction beginning
in the ring finger of the left hand twelve years ago; in the
course of a year or two the disease extended to the little
finger, and afterwards to the middle finger. Four years since
a similar affection appeared in the right hand, and shortly
before admission he observed a superficial nodule on the sole
of each foot. He had never suffered from gout or rheumatism,
and had always enjoyed good health; the family history was
negative. On examination the third, fourth, and fifth fingers
were found contracted in both hands; the fourth and fifth
fingers of the left hand being strongly bent at the first and
second joints, and brought into contact with the palm, while on
the right side the lesions were similar in character but less
advanced. In each sole a flat subcutaneous nodule could be felt
adherent to the plantar fascia and slightly to the integument
over the head of the second metatarsal bone, but there was
no puckering of the skin, and the position of the toes was
quite unaffected. The contracted cords in both hands were
divided by multiple subcutaneous incisions, and the fingers
were extended by plaster-of-Paris splints. The nodule upon the
right sole was excised, and found to consist of white fibrous
tissue, longitudinally striated, and adherent to the fascia,
but could be detached from it without difficulty. Under the
microscope the appearances presented were identical with those
in the early stage of Dupuytren’s contraction, and there is no
doubt that the foot nodule was pathologically the same as the
contracted tissue in the hands. The operations upon the hands
and feet were successful.
CONTRACTIONS DUE TO DEVELOPMENTAL IRREGULARITIES IN THE ARTICULAR
STRUCTURES.
This group includes the conditions known as hammer toe, hallux flexus,
and some of the lateral versions of the toes.
HAMMER TOE.
This complaint may be described as a permanent flexion from the straight
line at either or both of the inter-phalangeal joints, without paralysis
of muscles, unattended with any primary degenerative or inflammatory
disease of the articular structures, and essentially confined in origin
to the period of active growth. Some precision of definition is necessary
to exclude similar deformities of wholly different pathological nature.
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