escribed by Morton
of Philadelphia (1876), is a neuralgia on the area of the anterior
metatarsal arch, specially located in the region of the heads of the
third and fourth metatarsal bones. It is most often met with in adults
between thirty and forty, is commoner in women than in men, and is
often combined with flat-foot. The patient complains of a dull aching
or of intense cramp-like pain in the anterior part of the foot. The
pain is usually relieved by rest and by taking off the boot. It may be
excited by pressing the heads of the metatarsals together or by
grasping the fourth metatarso-phalangeal joint between the finger and
thumb. In advanced cases the pain may be so severe as to cripple the
patient, so that she is obliged to use a crutch. On examination, the
sole may be found to be broadened across the balls of the toes, and
there may be corns over the heads of the third and fourth metatarsals.
Skiagrams may show a downward displacement of the head of one or other
of these bones, and prints of the foot may show an increased area of
contact in the region of the balls of the toes. The affection is of
insidious development, and is usually ascribed to sinking of the
transverse arch of the foot--pes transverso-planus--the result of
weakness or of wearing badly fitting boots. The intense pain is
believed to be due to stretching of, or pressure upon, the
interdigital nerves or the communicating branch between the medial and
lateral plantar nerves; Whitman believes it is due to abnormal side
pressure on the depressed articulations.

[Illustration: FIG. 156.--Radiogram of Spur on under aspect of
Calcaneus.]

_Treatment._--Great improvement usually results from treating
coexisting flat-foot, and pain is relieved by rest, massage, and
douching. A tight bandage or strip of plaster applied round the
instep before putting on the stocking may relieve pain. Boots should
be made from a plaster cast of the foot, high and narrow at the instep
so as to compress the bases of the metatarsals, and with the medial
edge of the sole and heel slightly raised; a support may be worn in
the sole, like that used for flat-foot, with both the longitudinal and
transverse arches exaggerated. Scholl has devised a support for the
anterior arch which we have used with benefit. When the head of one of
the metatarsals is displaced, it may be removed through a dorsal
incision running parallel with the tendon of the long extensor.

#Hallux Valgus and B