Looking at the great toe!

In medical English we have the word digit which describes either a toe or a finger. In Amharic the word ‘taat’ which some scripts write as ‘xat’ because the letter x is an explosive ‘t’, our ‘x’ is written ‘cks’. The big toe is called the ‘owra xat’.  ‘Owra’ is the added adjective to differentiate a rooster from a hen. It is an ‘owra doro’. So maybe we could call it the ‘rooster toe’.

Certainly the commonest thing with their big toes, in the West, for children, apart from getting their nails cut, are IGTN – or ingrown toenails. When I was in my early sixties I was not able to get a visa into Ethiopia and had a practice here in Australia. I did a few operations under local anaesthetics in my rooms. Things like small skin lesions, carpal tunnel blocks, vasectomies and IGTN.

Pre-teens and early teenagers don’t know what old really means. They think if you’re married and have a couple of kids then you’re ‘old’. One day I was operating on a young girl’s IGTN under local. She was a brave girl. We got talking and she mentioned this old man in some context for which, to me, ‘old’ didn’t seem correct. So I asked her what was the guys age – ’about 35’ she said. I said, ‘then what am I?’ The answer was that I wasn’t old. So I offered to do her other toe free if she wanted me to. She had the grace to laugh but one was enough for her, and besides, there wasn’t anything wrong with her other big toe.

Over the years one has seen a number of big toe issues. Bunions; fractures; cuts; dead bones in leprosy patients and rat bites; gout, arthritis, pyoderma gangrenosum ; cancer; dead toes particularly in diabetics or as a part of much more extensive gangrene in vascular disease. In Ethiopia we often saw people with six toes, usually on the outer side of the foot but not always.  Some extra digits were very simple to remove, some more difficult. Why would you want to do anything? For me it was simple – because the patient wanted it. Usually it had something to do with foot wear.

Usually the big toe is longer than the others. Once I operated and shortened the second toe of a state AFL player because every time he played he developed a blister or shallow ulcer on the end of his second toe. It helped him a lot.

It reminds one of the saying – ‘I complained about having no shoes until I saw someone who had no feet. And I stand amazed at what some can do with their feet when they have no hands. They play the piano, tie up their siblings’ shoelaces, in fact, live a full life. And have you seen that guy with no hands nor feet but a world renowned speaker? Amazing!

Going back to my young girl’s statement, I wonder what old really means. Do I measure it in chronological or physiological terms; human years, historical years or eternal years? At over 80, I still feel like a young man even though living in a wrecked old frame.

Dominic Cartier