3. Resection of the joint is undoubtedly the best operation in the more severe operations of hallux valgus. Involving the obliteration of an important articulation, it was feared that it might induce serious crippling, but the plan has been adopted with perfect success by Mr. Clutton[14] who, excising the cartilaginous extremities of the bones and fixing the shafts in suitable position by means of an ivory peg, has secured the best results. During the last two years I have applied the principle of the operation recommended for hammer toe. Excision of the head of the metatarsal bone is performed through a longitudinal incision over the inner side of the joint, the toe is then replaced and fixed for three weeks in a slightly extended position by means of plaster of Paris. The success of these measures is far more complete than could have been anticipated on theoretical grounds. The distal joint appears to replace almost perfectly that which is lost, and the locomotion is easy and unfatiguing. In a case of my own the patient was able to walk twenty miles a day within three months of the operation. HALLUX VARUS. [Illustration: FIG. 15. Hallux varus. A. Before operation; B. Three years after operation. The relatively small size of the great toe in B is due to the abnormally great development of the other toes (not represented in Fig. A).] The following is a curious example of this rare condition, in association with macrodactyly. The patient, a boy aged eleven, was admitted into St. Thomas’s Hospital in March 1887, with a deformity of the right great toe, dating from infancy. The member was somewhat imperfectly developed, and projected inwards almost at right angles with the metatarsal bone. (See Fig. 15, A.) A slightly prominent integumental fold was present on the inner side of the metatarso-phalangeal joint, and the ligamentous and other fibrous tissues beneath this resisted the replacement of the digit in its normal line. The toe could be moved feebly by an effort of the will, but the abnormal direction of the member prevented the muscles from exercising any useful function. The smaller toes were distinctly hypertrophied, but were otherwise well formed. The boy was unable to wear a boot, and was completely crippled. The toe was apparently useless, but it was judged advisable to restore it to its natural position rather than to amputate. This was effected by subcutaneous division of the internal lateral ligament and the application of a small plaster apparatus. Fifteen days later the child left the hospital with a light metal splint fixed to the inner side of the foot and toe. Three years afterwards he presented himself for examination, and it was found that the good result was more than maintained, as the toe was not only straight, but had acquired its normal size and considerable power of movement. The boy said he was able to walk seven or eight miles without fatigue. The relative hypertrophy of the lesser toes was still obvious.