A treatise on orthopedic surgery . e in the joint and sharp neuralgicpain referred to the terminal phalanx. In some cases the onsetof the symptoms may be ascribed to a long walk or mountainclimb, in others to wearing tight shoes, and in some instancesno definite cause can be assigned by the patient. In cases ofthis type the symptoms are often supposed to be evidences ofgout or rheumatism and in certain instances there is a distincthypertrophic change corresponding to Heberdens nodes on thefingers. Although in certain instances the discomfort may beaggravated by a constitutional disease, still
A treatise on orthopedic surgery . e in the joint and sharp neuralgicpain referred to the terminal phalanx. In some cases the onsetof the symptoms may be ascribed to a long walk or mountainclimb, in others to wearing tight shoes, and in some instancesno definite cause can be assigned by the patient. In cases ofthis type the symptoms are often supposed to be evidences ofgout or rheumatism and in certain instances there is a distincthypertrophic change corresponding to Heberdens nodes on thefingers. Although in certain instances the discomfort may beaggravated by a constitutional disease, still no relief can be ob-49 770 OBTHOPEDIC SUBGEBY. tained by medication unless it is combined with the local treat-ment that has been described in the preceding section. Therelief afforded by such treatment alone proves, in many in-stances, that the affection is purely local in its character (). As has been mentioned, pain referred to this joint is a com-mon symptom of the weak foot and of the contracted foot as well. Fig. ? Simple congenital varus, adduction without inversion—a form of pigeon-toe. It is also caused by simple pressure on the joint, and by the useof improper shoes which force the toes into the abductedposition. In rare instances pain directly beneath the great toe andsensitiveness to pressure about the sesamoid bones seem to indi-cate an inflammation of the tendon sheath or local the discomfort is persistent the sesamoid bones may be re-moved. As a rule, such symptoms occur only in combinationwith pain or deformity of the great toe-joint. If the extremityof the metatarsal bone is enlarged and if pain persists excisionis advisable. HALLUX VARUS. Adduction of the great toe is not infrequent in infancy, and itmay be associated with a slight degree of varus deformity (). The peculiarity attracts the mothers attention becauseof the difficulty of drawing on the socks. In many instances the BIS ABILITIES ANB BEFOBMITIES OF THE FOOT. I
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