Morton's Toe

Original Editor - Marlies Verbruggen

 Top Contributors -Andeela Hafeez, Marlies Verbruggen, WikiSysop, Edema Emmanuel, Kim Jackson, Admin, Joao Costa, Richard Benes and Chrysolite Jyothi Kommu  

Vector-generated image comparing a foot with (left) and without (right) Morton's toe. The dotted curve indicates the joint position.

Introduction 

A Morton’s toe otherwise called Morton's foot or Greek foot or Royal toe, is characterized by a longer second toe. his is because the first metatarsal, behind the big toe, is short compared to the second metatarsal, next to it. The longer second metatarsal puts the joint at the base of the second toe (the second metatarsophalangeal or MTP joint) further forward. It is a type of brachymetatarsia.

Brachymetatarsia is a condition in which the metatarsal physis closes prematurely yielding a pathologically shortened metatarsal length. It can affect any of the five metatarsal bones of the foot and it could be bilateral. Brachymetatarsia of the first metatarsal is also known as “Morton’s syndrome or Toe” 5

Morton's toe is a little misleading, because this condition is not really a long toe, meaning the phalanges (toe bones). It is the relative length of the Metatarsal foot bones, specifically the relative length difference between the first and second that defines this foot shape.

X-ray image of a patient with Morton's toe.

History

The name derives from American orthopedic surgeon Dudley Joy Morton (1884–1960),[2] who originally described it as part of Morton's triad (a.k.a. Morton's syndrome or Morton's foot syndrome) a congenital short first metatarsal bone, a hypermobile first metatarsal segment, and calluses under the second and third metatarsals.

Epidemiology

Tachdjian reported that first metatarsal is the most commonly affected metatarsal, although the incidence was found to be 1 in 10,000, whereas a majority of other podiatric and orthopaedic authors claim the fourth brachymetatarsia to be the most common. The largest series of studies, which are from Japan, report the incidence of Morton’s syndrome to be somewhere between 1 in 1820-4586 (0.022%-0.05%), and bilateral congenital brachymetatarsia is noted to be 72 %.

Aetiology

Morton’s toe can be caused by one or both of two problems that can affect the first metatarsal bone.

1. The first abnormal condition, and the most noted one, that can cause Morton’s Toe is where your first metatarsal bone is shorter than your second metatarsal bone.

2. The second condition that can cause a Morton’s Toe is when your first metatarsal bone is not as stable as it should be, and as a result, has too much motion. This is known as “Hypermobility of the First Metatarsal Bone.”

Pathophysiology

Pronation is the single most important term used in the discussion of how the foot works. The most common reason for people to have foot problems is due to an abnormal amount of Pronation.  Morton’s Toe will cause an individual to have abnormal or over pronation.  It is this pronation that is the ultimate cause or contributing factor to most of the problems not only of the foot but also of the whole body.

Pronation is a series of movements the foot must make in order for us to walk properly. But, it is not that simply.

There are two types of pronation of the foot,

1. normal pronation, or

2. abnormal, or over pronation

Normal Pronation is a series of motions the foot must have, so that it can absorb the shock of meeting the ground. It must be able to do this, in order to adapt and adjust to the new walking surfaces it has just met. This adjustment should only last a fraction of a second to allow the foot to slow down; absorb the shock of your body weight in order to adjust and adapt to the walking surface. At this point in time normal pronation is taking place and the foot is referred to as a “bag of bones” due to its ability to adapt to the new walking or running surfaces. Part of this process of becoming a “bag of bones” is that the arch will start to flatten out and roll toward the ground. Normal pronation should only last no longer than a moment for the foot to adjust. If this adjustments last longer then the foot will begin to abnormally pronate and to correct itself. This is the start of a “chain reaction” that puts the foot under a lot of abnormal stress and strain, causing  Bunions, Heel Spurs Plantar Fasciitis, Corns, Callouses, Ingrown Toenail and numerous other foot problems. 

Over or abnormal pronation occurs when the foot is still pronating when it shouldn’t be. Once the foot has adapted to the ground the foot should stop pronating and should be starting to stabilizing itself or locking itself. This locking is called Supination and is the opposite of Pronation. Supination must take place so the foot can become a “Rigid Lever*” (opposite of “bag of bones”) in order for it to support our body when we push off from the ground; and propel us forward for our next step. In Supination the arch of the foot goes up (instead of down as in Pronation) so that it can become the Ridge Lever. But, if you are Over Pronating and you still are a “Bag of Bones and not the Rigid Lever when pushing off from the ground, then your foot and body will attempt to stop the over pronation by compensation.

This compensation puts the bones, muscles, tendons, ligaments, and other structures under a tremendous amount of abnormal stress and strain not only of the foot but of the whole body. It is this abnormal stress caused by the body attempting to compensate that is the start of most of our feet and body wide problems. A short first metatarsal bone, and or hypermobility of the first metatarsal bone can lead to a lack of proper stabilization on the fore foot, at the critical moment when the foot must be a “ridge lever” in order for it to push off from the ground. This instability will force the foot to compensate in its attempt to become that “ridge lever”.

Associated Problems: 

This foot structure is known to cause and perpetuate musculoskeletal problems. Problems start with the feet and the list is long.

Foot Pain

• Metatarsalgia (ball-of-foot pain)
• Morton's Neuroma
• Metatarsal Stress Fractures
• Plantarfasciitis
• Calluses
• Bunion Hammer, Claw and Mallet toes

Lower Extremity Pain

• Ankle Pain - Weak Ankles
• Shin splints
• Tight, Sore and Tired Calf Muscles

• Knee pain

• Tight IT Bands
• Runner's Knee (Chondromalacia)
• Fractured Meniscus
• ACL Tears

• Sciatica Pain
• Arthritis

Back and Neck

• Scoliosis & Kyphosis
• SI Joint Pain
• Sciatica (Piriformis Syndrome)
• Low-Back Pain
• Upper Back and Shoulder Pain
• Neck Pain (head forward posture)
  

Treatment:

Proper treatment of Morton's Toe starts with selecting proper footwear. Footwear with a high and wide toe box (toe area) is ideal for treating this condition. It may be necessary to buy footwear a half size to a size larger to accommodate the longer second toe. Orthotics that feature arch support to keep the foot aligned, and a metatarsal pad to reduce stress on the ball-of-the-foot are often recommended when treating this condition. Proper footwear combined with a effective orthotic will provide relief from pain associated with Morton's Toe.

If you're not comfortable showing your toes, wear socks or slippers while indoors or trainers and other closed-shoes while outdoors.Make your feet look and feel good! Just because your toe is longer, doesn't mean it can't be pampered! Paint your toe nails with nail polish and keep your feet clean. This will make your feet look and feel good!