Out of the whole number only six confessed to having worn tight boots. In the rest, neither history nor inspection indicated any fault of the kind, and the feet in the great majority were perfectly well formed in all other respects, and bore no marks of injurious compression. In a case of inherited hammer toe in which the proximal joint of the second digit of the right foot was straightened by operation, the boots worn before and after the operation were made upon sound anatomical principles; but nevertheless the patient came two years later with a contraction of the distal joint of the same toe and of the middle toe of the opposite foot, and a lateral distortion of the fourth toe. The pathological explanation I believe to be that advanced to account for the occurrence of hammer finder. The examination of a large number of healthy feet will reveal physiological variations in the condition of the inter-phalangeal joints exactly comparable with those noted in the hands. The second phalanx may in some persons be super-extended 30° beyond the axial line of the proximal bone, while in other instances the movement is arrested by tension of the plantar fibres of the lateral ligaments before this line has been attained;[11] and in the distal joint even greater variation may be found. There is, in fact, a physiological tendency to hammer toe in large numbers of people who never actually suffer any inconvenience from it, and it is in the exaggeration of this physiological irregularity that we have to seek the pathology of the surgical hammer toe. The tendency ceases at adult life, because the ligamentous and bony structures of the articulation have then assumed their permanent condition, and any later deformity simulating it can only occur as a result of a totally different set of conditions. Hammer toe, then, like hammer finger, must be regarded as the result of inadequate longitudinal evolution of the ligaments which limit the movement of extension at the inter-phalangeal joints, and the symptoms induced by the deformity are mainly dependent upon the formation of callosities and bursæ by contact with the opposed hard surfaces of the foot covering. This irregularity of development may be either inherited or accidental. _Treatment._—It is probably not within our power to prevent the occurrence of hammer toe, even by the greatest care in the selection of boots. For its relief when developed many plans have been adopted, the chief of which are as follow: 1. Extension by splints of various kinds in the early stages, while the contraction may be overcome by passive force. The condition is rarely seen by the surgeon in this period, but should it fall under observation the persevering use of passive extension is preferable. When the deformity is well marked, splints are painful and useless.