What is Morton’s toe?
Morton’s toe is a condition where the second toe is longer than the big toe. It is also known as Morton’s foot or Greek foot. The longer second toe was first described in 1877 by American orthopedic surgeon Dr. Dudley J. Morton, hence the name Morton’s toe.
What causes Morton’s toe?
Morton’s toe is caused by an imbalance in the muscle strength between the first and second toes. The muscle that flexes the second toe (flexor digitorum longus) is usually stronger than the muscle that flexes the big toe (flexor hallucis longus). This causes the second toe to exert more pressure on the end of the bone, resulting in extra bone growth and a longer second toe.
The exact cause of this muscle imbalance is not fully understood but is likely related to genetics. Morton’s toe tends to run in families. Other potential contributing factors include:
– Wearing shoes that are too narrow or short for the foot size, crowding the toes
– High arches which put more pressure on the second toe
– Lax ligaments that allow excessive motion of the second toe
– Trauma or injury to the big toe
What are the symptoms of Morton’s toe?
In many cases, Morton’s toe does not cause any symptoms. The main indication is simply that the second toe appears longer than the first toe when looking at the feet.
Some common symptoms that can occur with Morton’s toe include:
– Pain, discomfort, or cramping in the toes or ball of the foot
– Calluses or corns on the tops of the toes due to friction against shoes
– Ingrown toenails on the longer second toe
– Difficulty finding properly fitting shoes due to the longer second toe
– Unusual wear pattern on shoes due to pressure from the longer toe
– Skin irritation, blisters, or ulcers between the first and second toes
More significant symptoms are less common but can include:
– Bunions or hammertoes of the shorter first toe
– Metatarsalgia (pain and inflammation in the ball of the foot)
– Stress fracture in the second metatarsal bone
– Arthritis in the MTP joints of the toes
How is Morton’s toe diagnosed?
Morton’s toe is easily diagnosed through a simple visual examination of the feet. The hallmark sign is that the second toe appears obviously longer than the first, great toe when looked at from above while standing.
To confirm the diagnosis, the podiatrist will also assess:
– Range of motion of the toes – the second toe will have greater flexion than the first toe
– Muscle strength – the muscle flexing the second toe will be stronger
– Observation while walking – the second toe will hit the ground first when walking
Other conditions like hammertoe or hallux valgus (bunion) of the great toe may be present. The podiatrist will check for any corns, calluses, or signs of unusual pressure patterns on the feet. An x-ray helps rule out any underlying bone deformity or arthritis.
What is the treatment for Morton’s toe?
Morton’s toe does not always require treatment if it is not causing any pain or significant symptoms. Wearing properly fitted shoes with a wide and deep toe box allows room for the longer second toe and helps prevent irritation.
Some conservative treatment options for symptomatic Morton’s toe include:
– Padding, gel sleeves, or toe spacers to cushion pressure areas
– Toe caps or braces to stabilize the toe
– Custom orthotics to redistribute weight off the second toe
– Exercises to stretch the calf and foot muscles and improve balance
– Icing and over-the-counter anti-inflammatory medication to reduce inflammation
If conservative treatments are ineffective, other options that may be considered include:
– Steroid injections to reduce inflammation and pain
– Surgery to release tight structures or align and shorten the longer second toe
Non-surgical treatment
Non-surgical treatments aim to relieve pain and pressure on the toes. Options may include:
– Padding and taping: Applying pads, cushions, or tape to protect painful areas and improve toe alignment.
– Toe spacers: Devices placed between the first and second toes to reduce friction and realign the toes.
– Orthotics: Custom shoe inserts that support the arch and distribute weight away from the second toe.
– Footwear modifications: Wearing shoes with a wide toe box, low heels, and proper arch support.
– Exercises: Stretching the feet and toes to increase flexibility and range of motion. Strengthening the muscles may also help.
– Medications: Over-the-counter NSAIDs (ibuprofen, naproxen) to relieve pain and inflammation.
Surgical treatment
If conservative treatments fail, surgical options may include:
– Soft tissue release: Cutting or lengthening tight ligaments and tendons around the first toe to allow better alignment.
– Bone procedures: Shortening or realigning long bones in the second toe to make it shorter.
– Joint fusion: Fusing joints in the second toe so it cannot move out of place. This provides stabilization but reduces motion.
– Tendon transfer: Moving a tendon attachment to rebalance muscle strength between the first and second toe.
The risks of surgery include infection, nerve damage, ongoing pain, and stiffness in the toe. Proper footwear and toe care are still needed after surgery.
What problems are associated with Morton’s toe?
Morton’s toe is usually more of a cosmetic concern, rather than a medical problem. However, it can contribute to various foot problems if there is excessive pressure on the longer second toe. Potential issues include:
– Calluses and corns – Thick, hardened skin over pressure points.
– Blisters and ulcers – Fluid-filled sores from friction and irritation.
– Ingrown toenails – Nail edge growing into skin, often affects second toe.
– Bunions – Bony bump on the joint of the great toe, from angulation.
– Hammertoes – Contracted, bent toes due to muscle imbalance.
– Metatarsalgia – Pain and inflammation in the ball of the foot.
– Stress fracture – Tiny crack in metatarsal bone from repetitive pressure.
– Arthritis – Wear-and-tear joint damage, which causes pain.
– Interdigital neuroma – Pinched nerve between the toes, causing numbness or pain.
Proper foot support and wearing appropriate footwear can help prevent many issues associated with Morton’s toe. Some cases require surgery to realign the toe or remove bony deformities.
What are the complications of Morton’s toe?
In most cases, Morton’s toe does not lead to any serious complications, especially if properly managed. However, some potential complications include:
– Persistent or worsening foot pain – If underlying conditions like metatarsalgia, neuroma, arthritis are not treated.
– Chronic pressure ulcers – Ulcers on the toes can worsen without orthotics or proper footwear.
– Toe deformity – A dislocated toe, crossover toe, or splayfoot deformity may develop over time.
– Hammertoes – Permanently bent, contracted toes due to muscle imbalance.
– Loss of toe function – Rigid, fused toes after surgery reduces mobility long-term.
– Infection – Blisters, ulcers, or surgery can lead to local infections.
– Gait abnormalities – Altered walking pattern to avoid pressure on affected toe.
– Diabetic foot problems – Those with diabetes are prone to foot ulcers and infections.
– Arthritis – Wear-and-tear in the toe joints over time.
Seeking appropriate treatment can prevent most complications. Those with underlying medical conditions like diabetes require extra care and monitoring.
Who is at risk for developing Morton’s toe?
Some key risk factors for developing Morton’s toe include:
– Genetics – Morton’s toe strongly runs in families. Inherited muscle imbalance predisposes some people.
– Poorly fitted shoes – Shoes that are too narrow or short can exacerbate Morton’s toe by squeezing the toes.
– High foot arches – High arches shift weight toward the second toe, making imbalance worse.
– Lax ligaments – Loose ligaments allow the second toe to slide out of place more easily.
– Injury to great toe – Jamming or breaking the great toe makes the imbalance between the toes worse.
– Rheumatoid arthritis – Inflammation can damage toe ligaments and joints.
– Diabetes – Nerve damage and poor circulation increase risk of foot deformities.
– Obesity – Excess weight puts more pressure on the feet during walking and standing.
– Pregnancy – Hormonal changes and extra weight can affect the feet.
Wearing properly fitted shoes and using orthotics provide prevention. Addressing high arches, injuries, and medical conditions also helps.
Is Morton’s toe hereditary?
Yes, Morton’s toe often runs in families and can be hereditary. The inherited trait is thought to be unequal strength or tension between the muscles that control the toes, leading to imbalance.
This hereditary muscle imbalance typically leads to a longer second toe from growth adaptation. The tendency for Morton’s toe can be passed down genetically through multiple generations.
Studies have found an increased prevalence of Morton’s toe among relatives compared to the general population. The risk of having Morton’s toe is significantly higher if a close family member also has the condition.
However, just because Morton’s toe runs in the family does not mean it is guaranteed to develop. Environmental factors like shoe-wear choices still play a role. Not all genetic traits manifest themselves, and sometimes the imbalance between the toes is subtle.
While the exact genes related to Morton’s toe have not been definitively identified, research suggests a clear hereditary link. People with a first-degree relative who has Morton’s toe have about a 5- to 6-fold greater risk of developing the condition themselves.
How common is Morton’s toe?
Morton’s toe is relatively common, occurring in an estimated 10-30% of the population. However, the prevalence varies significantly depending on geographic location and ethnicity.
Some key statistics on the occurrence of Morton’s toe include:
– Occurs in 15-20% of Caucasians
– Occurs in 40-55% of people of Greek descent
– Occurs in 60-70% of Egyptian populations
– More common in men than women
– Occurs in 10% of Chinese populations
– Occurs in about 10% of those with rheumatoid arthritis
The condition may be underdiagnosed since mild cases cause no symptoms. Shoe-wear can also obscure the relative toe lengths. The exact prevalence is difficult to determine conclusively since studies rely on visual diagnosis.
Morton’s toe becomes more apparent with age as the muscular imbalance leads to gradual elongation of the second toe. The prevalence also increases with certain foot conditions like bunions and hammertoes.
Can Morton’s toe be prevented?
It is not always possible to prevent Morton’s toe, especially when there is a genetic predisposition. However, certain preventative measures can help reduce the risk:
– Wear properly fitted shoes – Shoes with adequate toe room allow normal motion and positioning. Avoid pointed toe boxes or high heels.
– Use orthotics – Custom orthotics support the arch and redistribute weight off the second toe.
– Exercise toes and feet – Stretching the foot muscles helps alignment and flexibility of the toes.
– Tape toes – Taping or using toe spacers can train the great toe to remain in better position.
– Treat conditions early – Quickly treating injuries, arthritis, or deformities prevents worsening imbalance.
– Monitor children’s feet – Ensure proper shoe size and have children evaluated for high arches.
– Lose weight – Reducing weight minimizes pressure on the feet from walking and standing.
Prevention is more difficult in people with a strong family history. But following proper foot care habits can help reduce risk, even when a genetic tendency exists.
Can Morton’s toe be corrected?
In mild forms of Morton’s toe, non-surgical treatments can help correct and realign the toes to some degree. Options include:
– Padding and taping the toes
– Using toe spacers or sleeves between the first and second toes
– Wearing shoes with a wide, deep toe box
– Custom orthotics to redistribute weight
– Doing toe stretches and exercises to increase flexibility
– Steroid injections to relieve inflammation
However, these conservative measures may only provide temporary relief or alignment correction in moderate to severe cases.
Permanent correction of longer second toe often requires surgical intervention, such as:
– Bone shortening or realignment procedures
– Fusing the joint of the longer toe
– Tendon lengthening or transfer surgery
– Removal of bunions or bone spurs on the great toe
The risks of surgery must be balanced against the benefits for each individual patient and case. Maintaining proper footwear and foot care routines after surgery can help sustain results.
Conclusion
Morton’s toe is a common foot condition where the second toe appears longer than the great toe. It is caused by an inherited imbalance in the foot muscles and exacerbated by environmental factors like shoe choice.
Symptoms are typically mild like cosmetic concerns, calluses, and difficulty finding well-fitting shoes. But more severe complications like toe deformity, arthritis, and gait abnormalities can occur.
Conservative treatments aim to relieve pressure on the longer toe. But surgical correction is often necessary to permanently shorten or realign the longer second toe in moderate-to-severe cases.
With proper foot care and well-fitted shoes, most people with Morton’s toe can manage well and prevent major complications. Paying attention to changes in the feet and seeking care when problems arise leads to the best outcomes.