The disease is chiefly found in male adults between twenty-five and thirty years of age.
Symptomatology and Treatment
In 90% of cases the little toe is the one affected, more rarely the fourth toe or very rarely both the fourth and little toe. The little toes may be attacked at the same time but the condition usually first starts in one toe. At first we have a crack in the digito-plantar fold of the little toe. This extends laterally and finally appears on the dorsum. The distal portion of the toe enlarges and becomes bulbous so that it looks like a small potato. The connection between the foot and the bloated-looking toe is a limp fibrous cord which permits the toe to wabble in various directions and to interfere greatly with walking.
The course of the disease extends over several years if the toe is not amputated by cutting through the fibrous pedicle or as the result of ulceration from injury to the pedicle.
Goundou
General Considerations
This is a disease which almost exclusively affects the black race and is chiefly found in the West Coast of Africa, where it is called big-nose or dog-nose. It is also found occasionally in China and the Malay Peninsula.
The prominent root of the nose is due to exostoses from the nasal processes of the superior maxillary bones.
Nothing definite is known as to etiology. Suggestions have been made that it is connected with yaws, syphilis or leprosy. Again that it is due to rhinoscleroma. Maclaud thought the hypertrophied tissues to be incident to irritation from dipterous larvae in the nasal fossae. Pathologically we have spongy bone covered by a thin layer of compact bone.
Symptomatology and Treatment