In this condition, the great toe is deflected toward the outer side of the foot accompanied by structural changes in the great toe joint (first metatarsophalangeal joint). (See plate No. 15.) With this is usually associated an enlargement of the bursa, a small sack situated on the inner side of the joint. The enlargement of the bursa, caused by an acute or chronic inflammation, constitutes what is called a bunion. Accompanying this bunion, or alone, there may occur a thickening of the periosteum (covering of the bone) forming an exostosis (out-growth). A point of great importance, deserving careful attention, is that the anterior arch usually falls with the occurrence of all cases of Hallux Valgus excepting the mild ones.

This affection is caused by the individual's wearing pointed toe shoes of the English type in which the inner side of the sole is not a continuation of a straight line formed by the heel but curves outward thereby causing the shoe upper to press against the great toe and great toe joint resulting in deformity when worn for any length of time. The great and almost universal prevalence of this condition are due to the popularity of the pointed toe shoe.

Treatment is directed toward mitigating the condition or more radical treatment such as operative measures. The former will be discussed. Before anything is done the shoe should be inspected, the fit verified and the lining examined to

see if there are any wrinkles present. Should the shoe be correct in fit the inner edge of the sole may be raised by the insertion of leather wedges 3-g to "116 inch thick which throw the weight and consequent pressure away from the affected joint and toe? Again, a wad of gauze or felt pad held by adhesive. lust back of the great toe joint relieves harmful pressure and permits the great toe to move more freely. In all cases where facilities are at hand, the feet should be carefully measured and shoes accurately fitted,

If the shoes fit satisfactorily and are correct in other details additional comfort may be had by stretching the leather opposite the great toe joint. The military shoe with .plenty of room across the ball of the foot and a sole whose inner side is a continuation of a line from the inner side of the heel will gradually improve mild cases