Metatarsalgia Or Morton's Disease

This is a painful affection of one of the metatarsophalangeal joints, usually the fourth. Its pathology is not settled, but treatment is based on the supposition that the heads of the metatarsal bones become pressed together, usually by tight shoes. Relief is often afforded by separating the toes with cotton; by winding adhesive plaster - several thicknesses - around the affected toe; by supporting the arch by pads or plates; by inserting a narrow longitudinal pad; or by resection or amputation.

Resection Of The Metatarsophalangeal Joint

In hallux valgus resection of the head of the metatarsal bone may give rise to a stiff joint. If the ankylosis is in a somewhat extended position, walking may not be impaired.

Fig. 603.   Dorsal luxation of the proximal phalanx of the second toe. Notice the shortening of the toe, its separation from the third toe. and the fulness over the head of the metatarsal bone. (From a sketch by the author).

Fig. 603. - Dorsal luxation of the proximal phalanx of the second toe. Notice the shortening of the toe, its separation from the third toe. and the fulness over the head of the metatarsal bone. (From a sketch by the author).

Excision of these joints may, and often does, give rise to a flail-like condition. The affected toe is deprived of its support and becomes displaced. Sometimes it gets beneath the adjoining toes and pain is caused by their superincumbent pressure. In other cases the toe is squeezed up above the level of the adjoining ones and is rubbed by the shoe above, causing painful corns. In either case the toe affected is a source of misery and not infrequently may require to be amputated. For these reasons excisions are seldom resorted to except in cases of hallux valgus.

Amputation Of The Toes

Amputation of the phalanges does not cause serious disability, but the loss of the head of the first metatarsal bone seriously weakens the foot.

Fig. 604.   Amputation of a toe at the metatarsophalangeal joint, with lateral flaps, showing method of disarticulating.

Fig. 604. - Amputation of a toe at the metatarsophalangeal joint, with lateral flaps, showing method of disarticulating.

Amputation of the outer four toes at the metatarsophalangeal joint is a dim-cult operation because, unless one is well informed, it will be hard to strike the joint. It should be sought about 1 cm. (2/5 in.) behind the web on the dorsal aspect, and if approached on the plantar aspect especial care is to be exercised not to go too far back and search for it on the neck of the metatarsal bone (Fig. 604). As in the hand so also in the foot when the proximal phalanx is bent the prominence (or knuckle) is formed by the head of the proximal (metatarsal) bone.