BUNION.
Preventive Treatment.—The cause of this condition (which is usually associated with hallux valgus or deviation of the great toe from the inner line of the body) is the wearing of narrow boots or shoes. These must be discarded for wide-soled boots with square roomy toes and low broad heels.
By a simple device the writer has prevented the development of the affection in cases coming early under notice. Ile directs the patient to place the tondo Achillis of one foot between the great and second toe of the opposite one before going to sleep on his side; this plan is applicable when only one foot is affected. A splint of leather moulded to the inner side of the foot to which the great toe can be bandaged at night, " tated " socks with a separate compartment for the great toe, and boots containing a toe-post on the same principle should be worn through the day.
The induration constituting the developed bunion is often painful and may require the application of soothing lotions or counter-irritants. Strong Iodine or pure Carbolic _keit] may be applied to the inflamed thickening, and rest must be prescribed. In mild cases pain may be re
lieved by wearing a suitable felt plaster with a large central opening; this gives considerable relief when rheumatoid arthritis complicates the case.
Where marked deformity, pain and lameness are present, the only treatment of any use is to make a free incision by Mayo's method, and remove the head of the metatarsal bone by forceps, after which the end of the shaft of the bone is trimmed as smoothly as possible, and the flap of the bursa secured by sutures, so as to separate it permanently from the cartilaginous surface on the base of the first phalanx.
Where the deformity is marked hut not associated with pain in the joint, the latter may be retained by removing a wedge from the shaft of the first metatarsal bone behind its head.
Where the sesamoid bones are tender on pressure. they, or one of them, should be removed.