Morton’s Toe

Introduction 

Comparison of vector-generated images of feet with (left) and without (right) Morton’s toes. Dashed lines indicate joint locations.

The Morton’s toe, also known as the Morton foot or the Greek foot or the Royal toe, is characterized by a longer second toe. This is because the first dorsal surface of the big toe is comparatively short. The second long metatarsal positions the joint… The second toe (second metatarsophalangeal joint or MTP joint) is further forward. This is a short foot deformity. [1]

Short metatarsalosis is a condition in which premature closure of the metatarsal plates results in a pathologically shortened metatarsal length. It can affect any of the five metatarsals of the foot and may be bilateral. The short metatarsal of the first metatarsal is also called “Morton’s Syndrome or Toes”[2]

Morton’s toes is a bit misleading, as the condition is not really long toes, meaning the phalanges (toe bones). It is the relative lengths of the metatarsals, especially the relative length difference between the first and second, that define this foot shape. [3]

Image: Metatarsals of the foot (highlighted in green) – bottom view [4]

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

History

The name is derived from American plastic surgeon Dudley Joy Morton (1884-1960) [5], who originally described it as part of Morton’s triad (also known as Morton’s syndrome or Morton’s foot syndrome), a congenital short First metatarsal, hypermobile first metatarsal segment and calluses Under the second and third metatarsals. [1]

Epidemiology

Tachdjian [6] reported that the first metatarsal was the most commonly affected metatarsal, although the incidence was found to be 1 in 10,000, whereas most other podiatric and orthopedic authors claimed that the fourth short metatarsal was the most common.

The largest series from Japan reported an incidence of 1 (0.022%-0.05%) for Morton syndrome between 1820-4586 and a 72% incidence of bilateral congenital brachypedia. [1]

In most podiatric and orthopedic literature, there is a strong preference for women over men. The average ratio was 25:1[1][7] and most of the population studied was between 5 and 14 years old. [8]

Aetiology

The etiology of Morton’s toe may be related to idiopathic congenital and acquired diseases. Idiopathic congenital disorders can include congenital disorders such as hereditary early closure of the epiphyseal plate, such as Down’s Turner syndrome Larsen-Albright syndrome, pseudohypoparathyroidism, polio, dystrophic dysplasia, pseudohyperparathyroidism, multiple epiphyseal dysplasia, and myositis ossificans.

Acquired infections may include trauma neurotrophic disorder radiation exposure surgical excision of the metatarsal head or osteochondrosis.[9]

As a result, Morton’s toe may have one or both of two problems affecting the first metatarsal.

1. The first metatarsal is shorter than the second metatarsal.

2. Hypermobility or instability of the first metatarsal [10]

These in turn affect the normal walking process and put pressure on the second metatarsal during the toe-off phase.

Short and/or hypermobility of the first metatarsal is a two-headed monster that reduces the ability of the first metatarsal to function properly. It causes excessive pronation when walking and results in increased stress and pressure not only on the feet but on the entire body. [10]

Pathophysiology

Pronation is the most important term used when discussing how the foot works. The most common reason people develop foot problems is due to an abnormal amount of pronation. Morton’s toe can cause abnormal or excessive pronation in an individual. It is this internal rotation [10] The ultimate cause or contributing factor to most problems is not just a foot problem, but a whole body problem.

Pronation is the series of movements the foot must make in order for us to walk properly. But it’s not that simple.

There are two types of pronation

1. normal pronation, or

2. abnormal, or over-pronation

Normal pronation is the series of movements the foot must perform to absorb the shock of contact with the ground. It has to be able to do this in order to adapt and adjust to the new walking surface it has just encountered. This adjustment should only last a fraction of a second to slow the foot down Eat down; absorb the shock of body weight to adjust and adapt to the walking surface. [10] At this point in time, normal pronation is occurring and the foot is referred to as a “bag of bones” as it adapts to the new walking or running surface. this part The process of becoming a “bag of bones” is when the arch begins to flatten and roll toward the ground. Normal pronation should only last no more than a moment of foot adjustment. If these adjustments last longer, the foot will start to pronate and straighten abnormally itself. This is the beginning of a “chain reaction” that puts the foot under a lot of abnormal pressure and strain, leading to bunions, heel spurs, plantar fasciitis, calluses, ingrown toenails, and many other foot problems [10].

Excessive or abnormal pronation occurs when the foot is still pronating when it shouldn’t. Once the foot has adjusted to the ground, the foot should stop pronating and should begin to stabilize itself or lock itself out. This locking is called supination, which is the opposite of pronation. Supination is necessary so that the foot becomes a “rigid lever*” (as opposed to a “bag of bones”) to support our body as we push off the ground and propel us forward to take the next step. In supination the arch is up (rather than in the pronation), making it a spinal lever. But if you over-pronate and you’re still a “bone bag instead of a rigid lever” when pushing off the ground then your foot and body will try to stop the over-pronation by compensating.

This compensation subjects the bones, muscles, tendons, ligaments and other structures to enormous abnormal stresses and strains, not only in the feet but throughout the body. It’s this abnormal pressure caused by the body’s attempt to compensate that is the start of most of our feet, Systemic problems. A short first metatarsal and/or an overactive first metatarsal can lead to a lack of proper stability in the forefoot at critical moments when the foot must be the “spine lever” to push it off the ground. This instability will Forcing the foot to compensate it’s trying to be that “spine lever”. [10]

Associated Problems: 

This foot structure is known to cause and perpetuate musculoskeletal problems. The problem starts with the feet, and the list is long. [3]

Foot Pain

• Metatarsalgia (ball-of-foot pain)
• Morton’s Neuroma
• Metatarsal Stress Fractures[10]
• 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 and thoracic kyphosis
• SI Joint Pain
• Sciatica (Piriformis Syndrome)
• Low-Back Pain
• Upper Back and Shoulder Pain
• Neck Pain (head forward posture)[3]

Treatment

There are a variety of treatments available for conservative treatment and surgical correction of Morton’s toe. [2] Foot surgery is a last resort, not first aid. [10]

Conservative Intervention

1. Orthotics: Orthotics with arch support to keep the foot aligned and metatarsal pads to relieve pressure on the ball of the foot are often recommended when treating this condition.

2. Metatarsal Pads[2]: Basic and simple for Morton’s toes and most problems associated with them such as back pain, knee pain, hip pain, fibromyalgia, arthritis and most foot pain The treatment is to place a pad on the sole of your first foot, the metatarsal bone we call the “toe” Upholstered. ” It was first written by Dr. Morton in 1927. [10]

3. Wide toe shoe covers: Proper treatment for Morton’s toe starts with choosing the right shoe. Shoes with a tall and wide toe box (toe area) are ideal for treating this condition. You may need to buy a half size up to a size up to accommodate a longer second toe. appropriate Footwear combined with an effective orthotic will reduce the pain associated with Morton’s toe. [11]

Taping can also be used to reduce hypermobility and strengthen the transverse arch of the foot.

[12]

Surgical Intervention

1. Metatarsal heads 2-4 resection.

2. Proximal 2nd-4th metatarsal osteotomy followed by implant arthroplasty in the 1st metatarsal (Teflon prosthesis) [13]

3. Chiappara procedure [14]: shortening of the first proximal phalanx combined with shortening of the proximal metatarsals 2 3 4 and lengthening of the medial cuneiform—allowing the interphalangeal joint (IPJ) of the hallux to compensate for the first metatarsophalangeal (MTP) joint. [13]