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In hallux valgus, the metatarso-phalangeal joint of the great toe undergoes changes characteristic of arthritis deformans.
In this connection it is worthy of note that there are certain points at which gangrene naturally tends to become arrested namely, at the highly vascular areas in the neighbourhood of joints. Thus gangrene of the great toe often stops when it reaches the metatarso-phalangeal joint; or if it trespasses this limit it may be arrested either at the tarso-metatarsal or at the ankle joint.
The deposit of urates in the synovial membrane is attended with effusion into the joint and the formation of adhesions, while in the ligaments and peri-articular structures it leads to the formation of scar tissue. The metatarso-phalangeal joint of the great toe, on one or on both sides, is that most frequently affected.
However, there are well-authenticated cases in infants, and again in persons over seventy years of age. In some few cases the metatarso-phalangeal joint is affected; but no case has been seen at the base of the ungual phalanx. The duration of the disease is between two and four years, but Dr. Evans's case had been in progress fifty years. It rarely runs its full course before a year.
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