Morton's toe

Morton's toe is the condition of having a first metatarsal which is short in relation to the second metatarsal (see diagram). It is a type of brachymetatarsia.[1]

This article is about the shape of the foot bones. For the condition involving the soft tissue between the bones, see Morton's metatarsalgia.
Morton's toe
Other namesMorton's foot, Greek foot, royal toe, Turkey toe, LaMay toe, Sheppard's toe, Coup d’etoe, Viking toe, Morton's syndrome,[1] long toe, boss 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.
SpecialtyOrthopedic

The distal metatarsal bones vary in relative length compared to the proximal. 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, as shown in the X-ray.

Presentation
In some people with Morton's toe, the second toe is clearly longer than the big toe.
X-ray photograph of feet exhibiting Morton's toe
Occasionally, Morton's toe can be severe enough that the third toe also appears longer than the first.

The most common symptom experienced due to Morton's toe is callusing and/or discomfort of the metatarsal heads at the base of the second phalanges. The first metatarsal head 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.[2]

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[3] 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,[3][4] and shoes are often too tight on the toes.[5] A tight shoe toebox can also cause hammertoes.[6][7]

Associated condition

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.

Treatment

Asymptomatic anatomical variations in feet generally do not need treatment.[8]

Conservative treatment for foot pain with Morton's toe may involve exercises[9] or placing a flexible pad under the first toe and metatarsal;[2] an early version of the latter treatment was once patented by Dudley Joy Morton.[10] 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. Rare cases of disabling pain are sometimes treated surgically.

Prevalence

Morton's toe is a minority variant of foot shape. Its recorded prevalence varies in different populations, with estimates from 2.95% to 22%.[8][11][3]

Etymology

The name derives from American orthopedic surgeon Dudley Joy Morton (1884–1960),[12] who originally described it as part of Morton's triad (a.k.a. Morton's syndrome or Morton's foot syndrome):[1] 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).[13]

Culture

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). It was an idealized form in Greek sculpture, and this persisted as an aesthetic standard through Roman and Renaissance periods and later (the Statue of Liberty has toes of this proportion). 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.[14]

See also

Notes
  1. Schimizzi, A; Brage, M (September 2004). "Brachymetatarsia". Foot Ankle Clin. 9 (3): 555–70, ix. doi:10.1016/j.fcl.2004.05.002. PMID 15324790.
  2. Decherchi, Patrick (2005). "Dudley Joy Morton's foot syndrome". Presse Médicale. 34 (22 Pt 1): 1737–40. doi:10.1016/S0755-4982(05)84262-9. PMID 16374398.
  3. Ogawa R, Hyakusoku H (2006). "Does Egyptian foot present an increased risk of ingrown toenail?". Plastic and Reconstructive Surgery. 117 (6): 2111–2112. doi:10.1097/01.prs.0000214750.33936.45. PMID 16652022.
  4. Gibbs RC (1985). "Toe nail disease secondary to poorly fitting shoes or abnormal biomechanics". Cutis. 36 (5): 399–400. PMID 4064760.
  5. d'Août, K.; Pataky, T.C.; De Clercq, D.; Aerts, P. (2009). "The effects of habitual footwear use: Foot shape and function in native barefoot walkers†". Footwear Science. 1 (2): 81–94. doi:10.1080/19424280903386411.
  6. Ellington, JK (December 2011). "Hammertoes and clawtoes: proximal interphalangeal joint correction". Foot and Ankle Clinics. 16 (4): 547–58. doi:10.1016/j.fcl.2011.08.010. PMID 22118228.
  7. Publishing, Harvard Health. "Hammertoe". Harvard Health.
  8. Young, Craig C.; Niedfeldt, Mark W.; Morris, George A.; Eerkes, Kevin J. (2005). "Clinical Examination of the Foot and Ankle" (PDF). Primary Care: Clinics in Office Practice. 32 (1): 105–132. doi:10.1016/j.pop.2004.11.002. PMID 15831315. Archived from the original (PDF) on 2017-05-17. Retrieved 2016-01-25.
  9. Yoo, Won-gyu (2014). "Effect of the Intrinsic Foot Muscle Exercise Combined with Interphalangeal Flexion Exercise on Metatarsalgia with Morton's Toe". Journal of Physical Therapy Science. 26 (12): 1997–1998. doi:10.1589/jpts.26.1997. PMC 4273076. PMID 25540516.
  10. "Means for compensating for foot abnormalities". freepatentsonline.com. Retrieved 13 November 2016.
  11. Online Mendelian Inheritance in Man: An Online Catalog of Human Genes and Genetic Disorders. http://www.omim.org/entry/189200
  12. Morton's syndrome (Dudley Joy Morton) at Who Named It?
  13. http://www.whonamedit.com/doctor.cfm/2324.html Thomas George Morton
  14. Kuhn, H; Gerdes-Kuhn, R; Küster, H.-H. (November 2003). "Zur Historie der Civinini-Durlacher-Neuropathie, genannt Morton Metatarsalgie". Fuss & Sprunggelenk.

References
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