The toes are shorter than the fingers and are not so often injured. When injured or diseased healing may be delayed by the constant motion to which they are subjected. For this reason rest should be enforced in obstinate cases by the application of bandages or splints.

Ingrown Nail

This usually affects the big toe. It is caused commonly by the irritation and pressure of badly-shaped shoes. To cure it the side of the nail is sometimes removed. In so doing the nail should be removed well beyond the skin margin at the matrix otherwise it is reproduced in a distorted form. It requires several months for a new nail to grow out from the matrix. Packing cotton soaked in a solution of nitrate of silver, 10 grains to the ounce, beneath the edge of the nail destroys the infection, lessens the pressure, and usually relieves the acute trouble in a few days.

Hammer Toe

This is a contraction of one of the toes, most often the second. The deformity is usually consecutive to the use of badly fitting shoes. Walsham ("Deformities of the Human Foot"), Shattock, and Anderson believe it to depend on a contraction of the plantar fibres of the lateral ligaments and glenoid ligament on the under side of the joint. Others hold it to be a contraction of the tendons. In treatment both conditions have to be considered. On pulling the toes the extensor tendon is put on the stretch, it should be divided, the remaining contractures are then either cut or broken by forcible stretching and the toe kept straight by bandaging until all tendency to contraction has been corrected. As a last resort resection of the joint is performed (Fig. 602).

Fig. 602.   Hammer toe. (From author's sketch).

Fig. 602. - Hammer-toe. (From author's sketch).

Luxation Of The Toes

The big toe may become dislocated by direct violence; the lesion is often compound. The displacement is most often backward on the dorsum of the metatarsal bone. When the injury is not compound the same difficulty may be experienced in reducing it as occurs in dislocation of the thumb. The cause is the same. The head of the metatarsal bone becomes caught in the fibrous tissues of the capsule and between the two heads of the flexor brevis hallucis muscle. These each contain a sesamoid bone. The detachment of one of these heads from the base of the first phalanx may be necessary before replacement can be effected.

Dislocation of the other individual toes is not nearly so rare as it is thought to be. It results from jumping from a height and landing, perhaps on an uneven surface, with the toes. The proximal phalanx may be displaced upon the metatarsal bone and the resulting pain is often considered to be merely a sprain.

The head of the affected metatarsal bone can be felt projecting in the sole, the toe is shortened and the space between it and the adjacent one usually increased; but the diagnosis is difficult and is best established by means of a skiagraph. Reduction is difficult and even when accomplished is not apt to remain (Fig. 603). Resection may be required.