vent any attempt at
dorsiflexion in walking.

#Hammer-toe.#--This is a flexion-contracture which generally involves
the second, but sometimes also other toes. It may be congenital and
inherited, but usually develops about puberty, and is then, as a rule,
bilateral, and often associated with flat-foot.

The first phalanx is dorsiflexed, and the second is plantar-flexed,
while the third varies in its attitude, sometimes being in line with
the second (Fig. 160), sometimes even more plantar-flexed, and
sometimes dorsiflexed. When the second toe alone is affected, as is
commonly the case, it is partly buried by those on either side of it,
only the knuckle of the first inter-phalangeal joint projecting above
the level of the other toes (Fig. 160). The skin over the head of the
first phalanx being pressed upon by the boot usually presents a corn,
under which a bursa forms (Fig. 161). Both the corn and the bursa are
subject to attacks of inflammation, which cause suffering and
disability in walking. The soft parts at the distal extremity of the
toe are flattened out by contact with the sole of the boot--hence the
supposed resemblance to the head of a hammer.

[Illustration: FIG. 160.--Hammer-toe.]

On dissection, it is found that the contracture is maintained by
shortening of the plantar portions of the collateral ligaments of the
first inter-phalangeal joint and of the glenoid ligament upon which
the head of the first phalanx rests.

Hammer-toe is usually ascribed to the use of tight socks and of
ill-fitting boots, especially those which are median-pointed and are
too short for the feet, but in some persons there appears to be an
inherited predisposition to the deformity.

[Illustration: FIG. 161.--Section of Hammer-toe.

_a_, Corn.
_b_, Bursa over first inter-phalangeal joint.]

While corrective manipulations, strapping, and the use of splints may
be of service in slight cases, it is usually necessary to perform an
operation in order to extend the toe permanently. Before operating,
any infective condition, such as a suppurating corn or bursa, must be
corrected. The collateral and glenoid ligaments are divided
subcutaneously--Spitzy also divides the flexor tendons and
capsule--and if the toe can then be straightened, the foot is secured
to a metal splint moulded to the sole and provided with longitudinal
slots opposite the intervals on either side of the toe affected. The
toe is drawn down to the splint by p