An analysis of my series of thirty cases shows that the deformity is much more frequent in boys the number including only three girls. (In the series of thirteen cases recorded by Mr. Makins the proportion of males to females was eleven to two). It was bilateral in one case only, right-sided in nineteen cases, left in ten, and affected the metatarso-phalangeal articulation in every instance, except two in which the distal joint was involved. (Fig. 11.) In only three cases did the flexion pass the prolonged axis of the metatarsal bone, the angle reached in the worst example being 150°; in the rest the toe during full extension was either in a line with the metatarsal bone, or formed with the latter a very obtuse angle, 170° to 160°, with the opening towards the dorsal aspect. The ages at which the symptoms were first noticed ranged from twelve to eighteen, in the greater number lying between fourteen and sixteen. The associated deformities were: excessive length of toe in two cases, this amounting to a distinct giant growth in one, hammer toe (second) in one, hallux valgus (slight) in three, flat-foot in four, and slight varus in one. In the other cases the feet were perfectly normal in shape. The duration of the disease before the patient came under treatment varied from three months to four years. Occupation appeared to exercise little influence; the subjects were mostly schoolboys, labourers, and errand boys, but there was no reason to believe that there had been any unusual strain upon the powers of endurance, except in two instances. In two cases the condition was attributed to the use of short boots, but in the others no complaint was made as to the foot covering, and that in wear at the time of attendance was as unobjectionable as the materials and plan of the modern boot will allow. Constitutionally, the patients were, for the most part, a little below the average in physique; one (a girl) was tuberculous, and one was a child of rheumatic parents, but none had suffered from rheumatism. The result of inquiries with respect to inherited tendencies was less striking than in the case of hammer toe. In one instance the father had double hammer toe, in another a brother had suffered from hallux flexus at the age of sixteen, and became cured without medical intervention in the course of three years; but in the majority no satisfactory information on the point could be obtained. [Illustration: FIG. 11. Hallux flexus of the distal joint.]