LATERAL DEVIATION OF THE LESSER TOES.
This is frequent in childhood. It was found in twenty-five children, twelve males and thirteen females, out of 800, the ages of the subjects ranging between five and fourteen. The version is usually at the first inter-phalangeal joint, but may also be present in the distal joint, and the toe much more frequently diverges towards the tibial than towards the fibular side (six to one). It may lie over or under its neighbour. The fourth toe is affected in about two-thirds of the cases, while the second, third, and fifth toes take an almost equal share in making up the remaining third. It is symmetrical in nearly two-thirds of the examples (sixteen out of twenty-five). In the early stage the joint may be straightened by passive force; but in the later, reposition is opposed by ligamentous tension, and perhaps by some alteration in the form of the bone. Like hammer toe, it occurs only during the developmental period, and there is no reason to connect it with any special defect in the shape of the shoe. In none of the examples under my own observation was it associated with hallux valgus; but a double hammer toe (third) was present in one case, and version of the fingers in three others. The children appeared to be in good health. The deformity may usually be relieved by the use of a splint, like that recommended for hammer toe; but in some cases a partial resection might be advisable.
Inversion of the little toe at the metatarso-phalangeal joint is occasionally met with. It appears always to arise during the period of active growth and is associated with shortening of the extensor tendon. Subcutaneous section of the tendon allows complete reposition, and the cure may be made permanent by temporary fixation in plaster, and subsequent attention to the feet. The origin of the condition is obscure.