. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. and bunions may develop, while an ingrowing toe-nail usually forms on the outer side of the great toe(Fig. 99). Clavus most commonly forms a circum-scribed thickening of the horny layer of the epider-mis, causing pain by pressure on the papillary nerveendings. Underneath the clavus a bursa generallyforms which may suppurate (bunion) and perforateexternally or into the joint. Clavus most often occurson the first and fifth toes. In hallux valgus and inhammer-toe clavi are always found,
. Atlas of clinical surgery; with special reference to diagnosis and treatment for practitioners and students. and bunions may develop, while an ingrowing toe-nail usually forms on the outer side of the great toe(Fig. 99). Clavus most commonly forms a circum-scribed thickening of the horny layer of the epider-mis, causing pain by pressure on the papillary nerveendings. Underneath the clavus a bursa generallyforms which may suppurate (bunion) and perforateexternally or into the joint. Clavus most often occurson the first and fifth toes. In hallux valgus and inhammer-toe clavi are always found, often betweentwo toes or under the toe-nails. Subungual exos-toses also occur in these cases (Fig. 140). Hammer-toe is an arthrogenous flexion contrac-ture usually aflFecting the second toe, as the result ofwearing too short boots, or secondary to halluxvalgus. The first phalanx is extended, the secondand third flexed. The third toe is rarely affected. Hallux valgus and hammer-toe are often com-bined with flat foot, and then render walking stillmore awkward and painful. 126 Bockenheimer, Atlas. Tab. Fig. 64. Hallux valgus — Hamtnerzehe — Arthrogciie Kontraktur. , New-York. Treatment. Prophylactic treatment consists inattention to tlie feet, baths, cutting the toe-nailsstraight instead of curved, properly made boots, etc. Hallux valgus, if it gives much trouble, is besttreated by cuneiform osteotomy of the metatarsusand subsequent correction in plaster of I*aris. Hammer-toe is often treated by fixation to a splint,after correction of the deformity, but this is unsatis-factory. It is better to cut through the soft parts atthe seat of flexion, and resect the joint from theextensor surface; or in bad cases to disarticulatethe toe. Exostoses can be chiseled; subungual exostosesafter removal of the nail. Clavi are best removed by the knife. In subun-gual clavus the nail must be removed first. Fistulafrom a bunion should be freely incised and cau-terized; o
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