In women, the chief complaint may be of the disfigurement of the boot; in others, of pain and disability resulting from the sensitiveness of the joint and of the enlarged bursa over the head of the first metatarsal. The inflamed bursa, which sometimes communicates with the joint, may suppurate, and the infection may spread to the joint.
The treatment varies with the severity of the deformity. In mild cases, a great deal can be done by wearing properly made boots and stockings with a separate compartment for the great toe, or a pad of cotton wool or tent of rubber between the great and second toes. The patient should practise manipulations and exercises of the toes and feet, and putting the foot to the ground properly in walking. In pronounced cases, the pain and tenderness must first be got rid of by rest and soothing applications. At night, the attitude of the toe may be corrected by a moulded splint fixed to the medial aspect of the foot by strips of plaster; the toe is then bandaged to the distal end of the splint. Scholl has devised a prop, made of rubber, to be worn between the great and second toes. If there is flat-foot, this must receive appropriate treatment.
In aggravated cases, the deformity can only be corrected by an operation which consists in resecting the head of the metatarsal bone, and the tendon of the long extensor may be detached from its insertion and secured to the medial side of the first phalanx. A bar may be placed across the sole just behind the balls of the toes, and the boot should also comply with the anatomical shape of the foot.
Hallux Varus or Pigeon-toe ([Fig. 158]).—In this deformity, which is extremely rare, the great toe deviates from the middle line of the foot; it occurs chiefly in children in conjunction with other deformities, and interferes with the wearing of boots. Treatment consists in straightening the toe and retaining it in position by a splint or plaster of Paris. The medial collateral ligament and the tendon of the abductor hallucis may require to be divided.
Fig. 158.—Radiogram of Hallux Varus or Pigeon-toe.
Hallux Rigidus and Hallux Flexus ([Fig. 159]).—These terms indicate two stages of an affection of the metatarso-phalangeal joint of the great toe, first described by Davies Colley. In the earlier stage—hallux rigidus—the toe is stiff and incapable of being dorsiflexed, although plantar-flexion is, as a rule, but little restricted. When the joint, in addition to being stiff, is painful, sensitive, and swollen, the term hallux dolorosus is applied.
