LATERAL DEVIATION OF THE LESSER TOES.
This is frequent in childhood. It was found in twenty-five children,
twelve males and thirteen females, out of 800, the ages of the subjects
ranging between five and fourteen. The version is usually at the first
inter-phalangeal joint, but may also be present in the distal joint, and
the toe much more frequently diverges towards the tibial than towards
the fibular side (six to one). It may lie over or under its neighbour.
The fourth toe is affected in about two-thirds of the cases, while the
second, third, and fifth toes take an almost equal share in making
up the remaining third. It is symmetrical in nearly two-thirds of the
examples (sixteen out of twenty-five). In the early stage the joint may
be straightened by passive force; but in the later, reposition is opposed
by ligamentous tension, and perhaps by some alteration in the form of the
bone. Like hammer toe, it occurs only during the developmental period,
and there is no reason to connect it with any special defect in the
shape of the shoe. In none of the examples under my own observation was
it associated with hallux valgus; but a double hammer toe (third) was
present in one case, and version of the fingers in three others. The
children appeared to be in good health. The deformity may usually be
relieved by the use of a splint, like that recommended for hammer toe;
but in some cases a partial resection might be advisable.
_Inversion of the little toe at the metatarso-phalangeal joint_ is
occasionally met with. It appears always to arise during the period of
active growth and is associated with shortening of the extensor tendon.
Subcutaneous section of the tendon allows complete reposition, and
the cure may be made permanent by temporary fixation in plaster, and
subsequent attention to the feet. The origin of the condition is obscure.
ARTHRITIC DEFORMITIES OF THE TOES.
_Arthritic hammer toe_ may be due to rheumatoid arthritis, gout,
rheumatism, or traumatic inflammation. The variety dependent upon
rheumatoid arthritis is the most common of these, and the most likely
to be brought under the eye of the surgeon. Its characteristics are
as follows: 1. It is not limited to the developmental period, and may
occur at any age in association with the causative disease, but it
is most frequently met with after middle life. 2. The deformity is
usually present in many or all of the toes and in both feet, and may
be associated with lateral (fibular) displacement of the digits, and
with bony outgrowths at the margin of the affected articulations. The
movements of the joints are much more impaired than in true hammer
toe, owing to changes in the cartilage; and fibrous ankylosis is often
present. 3. Manifestations of the causative disease may be found in other
parts of the body.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account