Misnaming and Misunderstanding

Many terms develop to become derogatory, despite originating with a benign meaning.
Thus some terms transmogrify to become catagorised as “vile” or “despicable” and many other similar deprecating terms. This reflects the common human heuristic (a short cut), demonstrating the inability to quantify within a spectrum. Humans rely upon “binary” neurology. Therefore the instant (emotional) categorization (heuristic) is either “good” or “bad”, “desirable” or “undesirable”, “repulsive” or “attractive”.
Where a spectrum is presented, new and specific words are evolved to demarcate each position on the spectrum as a distinct entity: This is illustrated in the colour spectrum, where a multitude of words have been evolved to describe each component of that spectrum.
What if this wording goes wrong? What if the wrong word is accepted as valid?
In orthopaedic surgery, in relation to the descriptions of the commonest deformity suffered by humans, such a misnomer is universally accepted, which has allowed an incorrect concept to evolve. Subsequently a plethora of incorrect surgical procedures have been invoked and inflicted upon an un-suspecting public.
That word is “metatarsal” when it is (incorrectly) applied to the longest bone supporting the great toe. That bone is, correctly, a phalanx. Thus the (human) great toe has – like all the other toes and fingers – three phalanges. What determines the correct appellation? Many bones have characteristic sites of the “growth plates”, seen only in the growing bone. In the phalanges that growth plate is “proximal” that is towards the head. In the metatarsal it is “peripheral”, that is away from the head.

Therefore the great toe, correctly, has three phalanges. The true metatarsal is reduced to become the short “medial cuneiform”. Such changes might be related to the evolution of an “opposable” first ray in both the hand and the foot (as an atavistic expression in the foot). This is an important concept because the commonest deformity of the great toe exactly emulates the (similar) deformity in the second toe, which is named “clawing” in the lesser toes (if untreated that might become a “hammer toe”).
Thus the cause of this deformity of the great toe duplicates exactly the cause of a “clawed” second toe. Consequently the appropriate treatment of the great toe deformity should duplicate the treatment of a “clawed” lesser toe.
Hallux valgus (and “metatarsus primus varus”, another fallacious term) recurs, following “conventional” surgery. This has spawned a number of scientific papers addressing the question “Does excessive laxity of the ‘metatarso-cuneiform joint’ predispose to recurrence of the condition?”. This is fatuous, since the anatomy of that joint has no bearing on the cause of the pathology. That joint only has a bearing on the “Hallux Paradox” (see elsewhere)


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