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Hallux valgus is met with more frequently than any other deformity of the adult foot. It is seen very occasionally in infants or children as a congenital deformity, but in the vast majority of instances it results directly from the long-continued deforming pressure of badly constructed shoes. Consequently it is found most commonly in women on account of the height of the heel and the narrowness of the toe in the so-called " smart " shoes which they usually wear, and as a rule the full development of the deformity is not seen before adult life.-The primary alteration in the alignment of the foot consists in the adduction of the great toe towards the outer border of the foot. This of itself constitutes the essential deformity of hallux valgus, and the alterations of the muscles, ligaments, and bones which are so commonly associated with this primary deviation are secondary to it and result from the abnormal position of the displaced great toe. Thus the head of the first metatarsal becomes abducted from the second, increasing considerably the width of the anterior portion of the first intermetatarsal space. This abduction of the metatarsal from its fellows often appears to be the outstanding and basic deformity, and may in some cases be associated with the presence of a small wedge-shaped bone, the intermetatarseum, which lies at the base of the first metatarsal between this bone and the internal cuneiform, and from the x-ray appearance it may seem that the abduction of the metatarsal is directly due to the presence of this abnormal bone. Such, however, is not the case, as in many instances the x-ray of an apparently normal foot has shown the presence of such a bone without any abduction of the metatarsal.The abduction, in fact, results directly from pressure applied by the base of the displaced first phalanx of the great toe on the inner side of the articular surface of the head of the first metatarsal, and correction of this abduction follows on removal of this abnormal pressure. Such an improvement in the alignment of the bone can usually be seen within a few days of the removal of this pressure, except in those old-standing cases where the articular surface of the base of the metatarsal has become altered as the result of the development of osteo-arthritic changes. A Vicious Muscular CircleBecause of the abduction of the first metatarsal the adductor obliquus and adductor transversus, which are attached to the inner side of the base of the first phalanx, are placed under increased tension, so that by their contraction the phalanx is pulled still further round to the inner side of the head of the metatarsal. The capsule on the inner aspect of the first metatarso-phalangeal joint becomes contracted, whilst that on the outer side of the joint is stretched, together with the abductor hallucis muscle, which is also attached on this aspect of the phalanx. The irregularly pitted, and is not capable of acting as an articular surface, even though the phalanx were restored to its normal position. Osteophytic outgrowths...

THE internal lateral ligament of the knee is a large complex structure which forms the inner aspect of the capsule of the knee-joint, of which it is in reality only a thickening. It is usually described as consisting of two definite and distinct portions, a long outer or superficial portion, and a short inner or deep portion ; but thew two apparently separate structures are only different parts of the same ligament.It consists of a large bundle of fibres which run from the femur almost vertically clown t o the tibia. The longer fibres are inserted a t the femoral end into a small dcpression on the inner aspect of the femur just below the addilctor tubercle, and a t the other end into a wider area on the inner aspect of the shaft of the tibia about one inch below the level of the knee-joint. The deeper short fibres are inserted, like the superficial, into both the femur and the tibia, close to the articular edges of the bones, and in addition have an attachment t o the flat inncr surface of the internal semilunar cartilage. This attachment of the internal lateral ligament t o the internal semilunar cartilage renders the ligament much more complicated in its structure and in its action than is the case with the external lateral ligament, which is only attached t o the femur and t o the head of the fibula, and has no attachment t o the external semilunar cartilage.I n order t o understand the action and injuries of the internal lateral ligament, it is necessary t o comprehend clearly its structure and points of attachment, especially of the deeper portion, because on this depends largely the occurrence of complications in injuries of the ligament. The deep portion is attached above to the lower end of the femur and below t o the upper end of the tibia, in each case close t o the articular surface and in combination with the capsule of the joint. I n its course it is attached, in association with the capsule, t o the inner flat aspect of the internal semilunar cartilage ; but the length of the ligament between its attachment t o the femur and the cartilage is not the same as t h a t between its attachment t o the tibia and the cartilage.The internal semilunar cartilage is closely bound down t o the head of the tibia by its anterior and posterior cornug, and attached round its outer border by the capsule and by the internal lateral ligament, so that in any movement of the knee-joint the cartilage moves in conjunction with the head of the tibia, and only the very slightest amount of movement is present between these two structures, except in the case of an internal derangement of t h r knee-joint. Between the cartilage and the femur, however, there is movement on any change of position of the joint, so that the portion of the ligament between the femur and the cartilage must necessarily be longer than would be necessary t o bridge the space between these two structures when the joint is at rest.When the knee-joint is fully extended, both parts of the internal lateral ligament are tense, so that no lateral mobility can ...

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