ule, but little
restricted. When the joint, in addition to being stiff, is painful,
sensitive, and swollen, the term _hallux dolorosus_ is applied.

[Illustration: FIG. 159.--Hallux Rigidus and Flexus in a boy aet. 17.
There is a suppurating corn over the head of the first metatarsal
bone.]

As the disease progresses, the toe is drawn towards the sole and
becomes permanently flexed--_hallux flexus_--and any attempt at
dorsiflexion is attended with pain.

The condition is met with chiefly in adolescent males, is nearly
always associated with flat-foot, and is then usually bilateral. The
patient's gait, in addition to having the characteristic features
associated with flat-foot, is peculiarly wooden and inelastic, as
instead of rising on the balls of the toes with each step, he puts
down and lifts the sole as if it were a rigid plate. The pain is
increased by walking. The boot tends to become worn away at the point
of the toes and at the posterior edge of the heel, and the usual
crease across the dorsum is absent.

On dissection it is found, especially in hallux flexus, that the
inferior portions of the collateral ligaments are contracted, and that
the cartilage of that part of the head of the metatarsal which is
exposed on the dorsum is converted into fibrous tissue; there may also
be other changes characteristic of arthritis deformans. Bony ankylosis
has not been observed.

_Treatment._--In early cases, great benefit results from measures
directed towards the cure of the accompanying flat-foot, and
especially the wearing of the support of the anterior arch devised by
Scholl. If the joint of the big toe is painful and sensitive, absolute
rest should be enforced until these symptoms have disappeared. The
patient must wear a properly shaped boot with a pliable sole, and be
instructed how to manipulate and exercise the toe. Later, when the toe
is already rigid or flexed towards the sole, the above treatment is
not feasible. It is then best to correct the deformity either by
wrenching the toe into the dorsiflexed position, under anaesthesia, and
fixing it with a plaster-of-Paris bandage; or, when this is
impossible, by excising the articular end of the metatarsal bone and
interposing a layer of fatty or bursal tissue between the distal end
of the metatarsal and the base of the first phalanx. When these
measures are impracticable, the suffering may be relieved by inserting
in the boot a rigid metal plate which will pre