A treatise on orthopedic surgery . arch, one of the very common results of impropershoes, may be present, yet unaccompanied by pain or discomfort. Depression of the anterior arch predisposes to pain becauseof abnormal pressure upon the persistently depressed articula-tions from beneath and it predisposes to pain, as the writer has^ Boston Medical and Surgical Journal, vol. cxxxi., p. 233, 756 OJRTHOPEDIC SUBGEBY. endeavorecP ? to explain, because the metatarsophalangeal jointsof an habitually depressed arch are exposed to the direct lateralcompression of a narrow or ill-shaped shoe. This point
A treatise on orthopedic surgery . arch, one of the very common results of impropershoes, may be present, yet unaccompanied by pain or discomfort. Depression of the anterior arch predisposes to pain becauseof abnormal pressure upon the persistently depressed articula-tions from beneath and it predisposes to pain, as the writer has^ Boston Medical and Surgical Journal, vol. cxxxi., p. 233, 756 OJRTHOPEDIC SUBGEBY. endeavorecP ? to explain, because the metatarsophalangeal jointsof an habitually depressed arch are exposed to the direct lateralcompression of a narrow or ill-shaped shoe. This point may be illustrated in the hand. When lateralpressure is applied, the hand is folded together and the anteriormetacarpal arch is increased in depth, but if the fingers aredorsiflexed so that it is fixed in a depressed position, thenlateral compression causes great pain at all the articulations(Fig. 49Y) ; or if one finger is dorsiflexed and the correspondingmetacarpal bone is thus forced below the level of its fellows. Fig. Position of the fingers corresponding to dorsiflexion of the toes, an attitude inwhich lateral pressure causes pain. lateral compression causes pain at the compressed joint. Or ifthe metacarpal bone of the little finger is made to over-ride thefourth, lateral pressure causes pain usually of a more acutecharacter than at the other joints, because the opportunity fordirect pressure is more favorable. Finally, if firm pressure ismade upon one or the other side of the head of the depressedmetacarpal bone of the dorsiflexed finger in the palm of thehand, a point of sensitiveness, representing apparently thedigital nerve, can be made out. The same experiments may betried upon the foot with the same results, and it would seem tomake clear the mechanism of the pain of Mortons neuralgia andthe allied forms of discomfort at the front of the foot. Anterior mctatarsalgia is in most instances the result of weak- 1 New York Medical Record, August 6, 1898. ^ This ana
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