Morton's toe | |
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Other names | Morton's syndrome [1] |
A Morton's toe that is so severe the second and third toe appear longer than the first toe. | |
Dorsal surface of a right foot with Morton's toe (left image) and without (right image). The dashed line highlights joint position. Metatarsals in yellow. | |
Specialty | Orthopedic |
Symptoms | A big toe that is short compared to the second toe |
Usual onset | Birth |
Duration | Life-long |
Frequency | 22% of the world population [2] |
Morton's toe is the condition of having a first metatarsal bone that is shorter than the second metatarsal (see diagram). It is a type of brachymetatarsia. [1] This condition is the result of a premature closing of the first metatarsal's growth plate, resulting in a short big toe, giving the second toe the appearance of being long compared to the first toe.[ medical citation needed ]
The metatarsal bones behind the toes are of different lengths, and the relative lengths vary between people. For most feet, a smooth curve can be traced through the joints at the bases of the toes (the metatarsal-phalangeal, or MTP, joints). But in Morton's foot, the line has to bend more sharply to go through the base of the big toe, as shown in the diagram. This 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 MTP joint at the base of the second toe further forward.
If the big toe and the second toe are the same length (as measured from the MTP joint to the tip, including only the toe bones or phalanges), then the second toe will protrude farther than the big toe, as shown in the photo. If the second toe is shorter than the big toe, the big toe may still protrude the furthest, or there may be little difference.
The most common symptom experienced due to Morton's toe is callusing and/or discomfort of the ball of the foot at the base of the second toe. The first metatarsal head (toeward end of the metatarsal, at the base of the big toe) would normally bear the majority of a person's body weight during the propulsive phases of gait, but because the second metatarsal head is farthest forward, the force is transferred there. Pain may also be felt in the arch of the foot, at the ankleward end of the first and second metatarsals. [3]
In shoe-wearing cultures, Morton's toe can be problematic. For instance, wearing shoes with a profile that does not accommodate a longer second toe may cause foot pain. A small (80-person) study [4] found no statistically significant difference in the frequency of longer second toes between people with and without ingrown toenails, but tight and ill-fitting shoes are generally considered to increase the risk of ingrown toenails, [4] [5] and shoes are often too tight on the toes. [6] A tight shoe toe box can also cause hammer toes. [7] [8]
Among the issues associated with Morton's toe is that the weight distribution causes the front of the foot to widen as the weight shifts from the first shortened toe to the others. Regular shoes will often cause metatarsalgia and neuromas as the shoe pushes together the toes hence the case of Morton's neuroma. Wide shoes are recommended.[ medical citation needed ]
Asymptomatic anatomical variations in feet generally do not need treatment. [9] Conservative treatment for foot pain with Morton's toe may involve exercises [10] or placing a flexible pad under the first toe and metatarsal; [3] an early version of the latter treatment was once patented by Dudley Joy Morton. [11] Restoring the Morton's toe to normal function with proprioceptive orthotics can help alleviate numerous problems of the feet such as metatarsalgia, hammer toes, bunions, Morton's neuroma, plantar fasciitis and general fatigue of the feet.[ medical citation needed ] Rare cases of disabling pain are sometimes treated surgically.
Morton's toe is a minority variant of foot shape. Its recorded prevalence varies in different populations, with estimates from 2.95% to 22%. [9] [4] A study by the Bulgarian Academy of Sciences found that it is far more prevalent among Bulgarians. [12] Another study on the Idoma people of Nigeria found almost a third of people have it. [13]
The name derives from American orthopedic surgeon Dudley Joy Morton (1884–1960), [14] who originally described it as part of Morton's triad, also known as Morton's syndrome or Morton's foot syndrome. [1] It is a congenital short first metatarsal bone, a hypermobile first metatarsal segment, and calluses under the second and third metatarsals. Confusion has arisen from "Morton's foot" being used for a different condition, Morton's metatarsalgia, which affects the space between the bones and is named after Thomas George Morton (1835–1903). [15]
Morton's toe, especially the second-toe-is-longer versions, has a long association with disputed anthropological and ethnic interpretations. Morton called it Metatarsus atavicus, considering it an atavism recalling prehuman grasping toes. In statuary and shoe fitting, a more-protuberant second toe has been called the Greek foot (as opposed to the Egyptian foot, where the great toe is longer). [16]
It was an idealized form in Greek sculpture (modern Greeks have an increased prevalence of Greek foot [17] ), and this persisted as an aesthetic standard through Roman and Renaissance periods and later on in neo-classical works such as on the Statue of Liberty which has toes of this proportion. [18] Some famous Classical and Renaissance art works featuring Morton's toe include Boxer at Rest, The Birth of Venus, Laocoön and His Sons and Diana of Versailles. [19] [20] [21]
There are also associations found within Celtic groups. The French call it commonly pied grec (just as the Italians call it piede greco) but sometimes pied ancestral or pied de Néanderthal. [16]
The foot is an anatomical structure found in many vertebrates. It is the terminal portion of a limb which bears weight and allows locomotion. In many animals with feet, the foot is a separate organ at the terminal part of the leg made up of one or more segments or bones, generally including claws and/or nails.
Toes are the digits of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being digitigrade. Humans, and other animals that walk on the soles of their feet, are described as being plantigrade; unguligrade animals are those that walk on hooves at the tips of their toes.
A bunion, also known as hallux valgus, is a deformity of the MTP joint connecting the big toe to the foot. The big toe often bends towards the other toes and the joint becomes red and painful. The onset of bunions is typically gradual. Complications may include bursitis or arthritis.
Pointe technique is part of classical ballet involving a technique that concerns pointe work, in which a ballet dancer supports all body weight on the tips of fully extended feet when wearing pointe shoes. A dancer is said to be en pointe when the body is supported in this manner, and a fully extended vertical foot is said to be en pointe when touching the floor, even when not bearing weight.
Diseases of the foot generally are not limited, that is they are related to or manifest elsewhere in the body. However, the foot is often the first place some of these diseases or a sign or symptom of others appear. This is because of the foot's distance from the central circulation, the heart and its constant exposure to pressures from the ground and the weight of the body.
A hammer toe, hammertoe or contracted toe is a deformity of the muscles and ligaments of the proximal interphalangeal joint of the second, third, fourth, or fifth toe, bending it into a shape resembling a hammer. In the early stage, a flexible hammertoe is movable at the joints; a rigid hammertoe joint cannot be moved and usually requires surgery.
An ingrown nail, also known as onychocryptosis is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the paronychium or nail bed. While ingrown nails can occur in the nails of both the hands and the feet, they occur most commonly with the toenails.
Navicular syndrome, often called navicular disease, is a syndrome of lameness problems in horses. It most commonly describes an inflammation or degeneration of the navicular bone and its surrounding tissues, usually on the front feet. It can lead to significant and even disabling lameness.
Metatarsalgia, literally 'metatarsal pain' and colloquially known as a stone bruise, is any painful foot condition affecting the metatarsal region of the foot. This is a common problem that can affect the joints and bones of the metatarsals.
Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces, which results in the entrapment of the affected nerve. The main symptoms are pain and/or numbness, sometimes relieved by ceasing to wear footwear with tight toe boxes and high heels. The condition is named after Thomas George Morton, though it was first correctly described by a chiropodist named Durlacher.
A subungual hematoma is a collection of blood (hematoma) underneath a toenail or fingernail. It can be extremely painful for an injury of its size, although otherwise it is not a serious medical condition.
The metatarsophalangeal joints are the joints between the metatarsal bones of the foot and the proximal bones of the toes. They are analogous to the knuckles of the hand, and are consequently known as toe knuckles in common speech. They are condyloid joints, meaning that an elliptical or rounded surface comes close to a shallow cavity. The region of skin directly below the joints forms the ball of the foot.
Hallux rigidus or stiff big toe is degenerative arthritis and stiffness due to bone spurs that affects the metatarsophalangeal joints (MTP) at the base of the hallux.
Tailor's bunion, also known as digitus quintus varus or bunionette, is a condition caused as a result of inflammation of the fifth metatarsal bone at the base of the little toe.
Mulder's sign is a physical exam finding associated with Morton's neuroma, which may be elicited while the patient is in the supine position on the examination table. The pain of the neuroma, as well as a click, can be produced by squeezing the two metatarsal heads together with one hand, while concomitantly putting pressure on the interdigital space with the other hand. With this technique, the pain of the Morton's neuroma will be localized strictly to the plantar surface of the involved interspace, with paresthesias radiating into the affected toes.
Brachymetatarsia is a rare malformation that causes one or more toes to be abnormally short. The condition is characterized by a metatarsal arch shortness of more than 5 mm. The condition is more common in females, and the incidence reported in the literature ranges from 0.02% to 0.05%. Brachymetatarsia appears to be the result of epiphyseal plate retardation or premature closure. The etiology may be congenital and idiopathic, posttraumatic, postinfection, iatrogenic, or secondary to a systemic disease such as cancer, sickle cell disease, pseudohyperparathyroidism, Turner's syndrome, Down syndrome, Apert syndrome, athyroidism, or osteodystrophy.
Freiberg disease, also known as a Freiberg infraction, is a form of avascular necrosis in the metatarsal bone of the foot. It generally develops in the second metatarsal, but can occur in any metatarsal. Physical stress causes multiple tiny fractures where the middle of the metatarsal meets the growth plate. These fractures impair blood flow to the end of the metatarsal resulting in the death of bone cells (osteonecrosis). It is an uncommon condition, occurring most often in young women, athletes, and those with abnormally long metatarsals. Approximately 80% of those diagnosed are women.
Running injuries affect about half of runners annually. The frequencies of various RRI depend on the type of running, such as speed and mileage. Some injuries are acute, caused by sudden overstress, such as side stitch, strains, and sprains. Many of the common injuries that affect runners are chronic, developing over longer periods as the result of overuse. Common overuse injuries include shin splints, stress fractures, Achilles tendinitis, Iliotibial band syndrome, Patellofemoral pain, and plantar fasciitis.
The toe box is the section of footwear that surrounds the toes on closed-toe shoes. Toe boxes that are too tight can cause injuries and foot deformities, whereas wider toe boxes may be used to treat or prevent common foot conditions such as broken toes, bunions, and Morton's neuroma. Toe boxes come in a variety of shapes and styles of construction, some of which are a matter of fashion, and some of which are designed for specialized functions.
A broken toe is a type of bone fracture. Symptoms include pain when the toe is touched near the break point, or compressed along its length. There may be bruising, swelling, stiffness, or displacement of the broken bone ends from their normal position.