assing a loop of cotton or elastic
bandage round the toe and through the slots. In many cases the
contraction of all the tissues on the plantar aspect, including the
skin, prevents the toe being straightened even after division of the
ligaments, and it is then necessary to remove the head and neck of the
first phalanx through a lateral incision. This is more satisfactory
than amputation of the affected toe at the metatarso-phalangeal
joint, as after this the adjacent toes tend to fall together and
favour hallux valgus. If amputation is performed, a pad of cotton wool
or rubber prop should be worn to fill up the vacant space.

The term _Gampsodactyly_ has been applied to a deformity in which all
the toes assume the position of hammer-toe, usually from a spastic
condition of the muscles controlling the toes.

#Hypertrophy of the Toes.#--One or more of the toes may be the seat of
hypertrophy or local giantism. This is usually present at birth or
appears in early childhood, and may form part of an overgrowth
involving the entire lower extremity (Fig. 162). The overgrowth may
involve all the tissues equally, or the subcutaneous fat may be
specially affected. The medial toes are those most commonly
hypertrophied. In addition to being enlarged, the toe may be displaced
from its normal axis. The hypertrophy may affect two or more toes
which are fused together or webbed (Fig. 162). The treatment consists
in amputating as much of the toe as will allow of an ordinary boot
being worn.

[Illustration: FIG. 162.--Congenital Hypertrophy of Left Lower
Extremity in a boy aet. 5. The second and third toes are fused.]

#Supernumerary Toes# (_Polydactylism_).--These vary from mere
appendages of skin to fully developed toes (Fig. 163); if they
interfere with the wearing of boots they should be removed.

#Webbing of the Toes# (_Syndactylism_).--This may affect two or more
toes, which may be united merely by a web of skin, or so completely
fused that the individual digits are only indicated by the nails; the
degree of fusion is shown by means of skiagrams. Unless associated
with congenital hypertrophy, no treatment is called for.

[Illustration: FIG. 163.--Supernumerary Great Toe.

(Photograph lent by Sir George T. Beatson.)]

THE UPPER EXTREMITY

#Congenital Absence of the Clavicle.#--Both clavicles may be absent,
and it is possible for the patient voluntarily to bring his shoulders
into contact with one another in front of the