Morton's toe
Encyclopedia
Morton's toe is the common term for the condition of a shortened first metatarsal in relation to the second metatarsal. It is a type of brachymetatarsia
. This promotes an anterior position of the second metatarsal-phalangeal
(MTP) joint in relation to the hallux
(big toe). The condition may or may not result in the second toe
(second from innermost) extending farther than the hallux if the second toe is of equal length to the big toe.
The name derives from American orthopedic surgeon Dudley Joy Morton (1884–1960), 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 callus
es under the second and third metatarsals.
Although commonly described as a disorder, it is sufficiently common to be considered a normal variant of foot shape (its prevalence varies with different populations). The main symptom experienced due to Morton's toe is discomfort and callusing of the second metatarsal head. This is because the first metatarsal head would normally bear the majority of a person's body weight during the propulsive phases of gait, but these forces are transferred to the second (smaller) metatarsal head because of its anterior positioning. In shoe-wearing cultures it can be problematic: for instance, in causing nail problems from wearing shoes with a profile that doesn't accommodate the longer second toe.
Confusion has arisen from the term also sometimes being used for a different condition, Morton's neuroma
, a term coined by Thomas George Morton (1835–1903) for a syndrome involving pain caused by neuroma
between the third and fourth toes.
recalling prehuman grasping toes. In statuary and shoe fitting it has been called the Greek foot (as opposed to the Egyptian foot, where the great toe is longer). A longer second toe has often been associated with royalty, particularly during the rule of the Ptolemaic dynasty
when Egypt was under Greek rulership. 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.
, MD, coauthor of The Trigger Point Manual, concluded that Morton’s Toe was "a major perpetrator of musculoskeletal dysfunction and pain." While the prevalence of Morton’s Toe is less than 50% in the general population, among people suffering from musculoskeletal pain and seeking medical help, it is thought to be well over 80%. The reason Morton’s Toe is often a precursor to musculoskeletal pain is its association with excessive pronation
of the foot. When weight bearing, the longitudinal arch of the foot drops, and the ankle rolls inward.
This excessive pronation causes two major postural and functional problems:
A functionally shortened toe behaves just like a structural short leg, unbalancing the pelvis by dropping one hip lower. This can cause various degrees of scoliosis
(improper lateral curves of the spine). The internally rotated leg causes a forward rotation of the pelvis, typically more on the side where the foot hyperpronates the most. The forward rotation of the hips causes changes in the kyphotic (anterior/posterior) curves of the spine and in general causes a forward-leaning, head-forward posture. The compromised posture combined with the torques created by internal leg rotation is often the cause of both joint and muscle pain ranging from knee and hip pain to low and general back pain and shoulder and neck pain. It is also believed by some to be associated with headaches and TMJ dysfunction
, although this is not universally accepted.
Restoring the Morton’s toe to normal function with proprioceptive orthotics
can help alleviate numerous problems of the feet such as Metatarsalgia
, hammer toe
s, bunion
s, Morton's neuroma
, Plantar Fasciitis
, and general fatigue of the feet.
Brachymetatarsia
Brachymetatarsia or hypoplastic metatarsal is a condition in which there is one or more abnormally short metatarsals. This condition may result due to a congenital defect or it may be an acquired condition. It most frequently involves the fourth metatarsal. If it involves the first metatarsal,...
. This promotes an anterior position of the second metatarsal-phalangeal
Phalanx bones
In anatomy, phalanx bones are those that form the fingers and toes. In primates such as humans and monkeys, the thumb and big toe have two phalanges, while the other fingers and toes consist of three. Phalanges are classified as long bones.The phalanges do not have individual names...
(MTP) joint in relation to the hallux
Hallux
In tetrapods, the hallux is the innermost toe of the foot. Despite its name it may not be the longest toe on the foot of some individuals...
(big toe). The condition may or may not result in the second toe
Toe
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...
(second from innermost) extending farther than the hallux if the second toe is of equal length to the big toe.
The name derives from American orthopedic surgeon Dudley Joy Morton (1884–1960), 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
Hypermobility
Hypermobility describes joints that stretch farther than is normal. For example, some hypermobile people can bend their thumbs backwards to their wrists, bend their knee joints backwards, put their leg behind the head or other contortionist performances...
first metatarsal segment, and callus
Callus
A callus is an especially toughened area of skin which has become relatively thick and hard in response to repeated friction, pressure, or other irritation. Rubbing that is too frequent or forceful will cause blisters rather than allow calluses to form. Since repeated contact is required, calluses...
es under the second and third metatarsals.
Although commonly described as a disorder, it is sufficiently common to be considered a normal variant of foot shape (its prevalence varies with different populations). The main symptom experienced due to Morton's toe is discomfort and callusing of the second metatarsal head. This is because the first metatarsal head would normally bear the majority of a person's body weight during the propulsive phases of gait, but these forces are transferred to the second (smaller) metatarsal head because of its anterior positioning. In shoe-wearing cultures it can be problematic: for instance, in causing nail problems from wearing shoes with a profile that doesn't accommodate the longer second toe.
Confusion has arisen from the term also sometimes being used for a different condition, Morton's neuroma
Morton's neuroma
Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the third and fourth intermetatarsal spaces.This problem is characterised by pain and/or numbness, sometimes relieved by removing footwear.Despite the name, the...
, a term coined by Thomas George Morton (1835–1903) for a syndrome involving pain caused by neuroma
Neuroma
A neuroma is a growth or tumor of nerve tissue. Just as the Latin word for swelling is now restricted to neoplasias, the equivalent Greek suffix -oma has shared in that fate. Thus, the typical modern usage of neuroma is for nerve tumors...
between the third and fourth toes.
Cultural associations
It has a long association with disputed anthropological and ethnic interpretations. Morton called it Metatarsus atavicus, considering it an atavismAtavism
Atavism is the tendency to revert to ancestral type. In biology, an atavism is an evolutionary throwback, such as traits reappearing which had disappeared generations before. Atavisms can occur in several ways...
recalling prehuman grasping toes. In statuary and shoe fitting it has been called the Greek foot (as opposed to the Egyptian foot, where the great toe is longer). A longer second toe has often been associated with royalty, particularly during the rule of the Ptolemaic dynasty
Ptolemaic dynasty
The Ptolemaic dynasty, was a Macedonian Greek royal family which ruled the Ptolemaic Empire in Egypt during the Hellenistic period. Their rule lasted for 275 years, from 305 BC to 30 BC...
when Egypt was under Greek rulership. 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
Statue of Liberty
The Statue of Liberty is a colossal neoclassical sculpture on Liberty Island in New York Harbor, designed by Frédéric Bartholdi and dedicated on October 28, 1886...
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.
Musculoskeletal dysfunction
Janet G. TravellJanet G. Travell
Dr. Janet Graeme Travell, M.D. was an American physician and medical researcher. She was born in 1901 to Willard and Janet Davidson Travell. Heavily influenced by her father's profession of physician, Travell made the decision to pursue a career in the medical field. In 1929, Janet married John...
, MD, coauthor of The Trigger Point Manual, concluded that Morton’s Toe was "a major perpetrator of musculoskeletal dysfunction and pain." While the prevalence of Morton’s Toe is less than 50% in the general population, among people suffering from musculoskeletal pain and seeking medical help, it is thought to be well over 80%. The reason Morton’s Toe is often a precursor to musculoskeletal pain is its association with excessive pronation
Pronation
In anatomy, pronation is a rotational movement of the forearm at the radioulnar joint, or of the foot at the subtalar and talocalcaneonavicular joints. For the forearm, when standing in the anatomical position, pronation will move the palm of the hand from an anterior-facing position to a...
of the foot. When weight bearing, the longitudinal arch of the foot drops, and the ankle rolls inward.
This excessive pronation causes two major postural and functional problems:
- The leg is functionally shortened or lengthened.
- The leg is rotated internally.
A functionally shortened toe behaves just like a structural short leg, unbalancing the pelvis by dropping one hip lower. This can cause various degrees of scoliosis
Scoliosis
Scoliosis is a medical condition in which a person's spine is curved from side to side. Although it is a complex three-dimensional deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an "S" or a "C" than a straight line...
(improper lateral curves of the spine). The internally rotated leg causes a forward rotation of the pelvis, typically more on the side where the foot hyperpronates the most. The forward rotation of the hips causes changes in the kyphotic (anterior/posterior) curves of the spine and in general causes a forward-leaning, head-forward posture. The compromised posture combined with the torques created by internal leg rotation is often the cause of both joint and muscle pain ranging from knee and hip pain to low and general back pain and shoulder and neck pain. It is also believed by some to be associated with headaches and TMJ dysfunction
Temporomandibular joint disorder
Temporomandibular joint disorder , or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment...
, although this is not universally accepted.
Restoring the Morton’s toe to normal function with proprioceptive orthotics
Orthotics
Orthotics is a specialty within the medical field concerned with the design, manufacture and application of orthoses. An orthosis is an orthopedic device that supports or corrects the function of a limb or the torso...
can help alleviate numerous problems of the feet such as Metatarsalgia
Metatarsalgia
Metatarsalgia is a general term used to refer to 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. Metatarsalgia is most often localized to the first metatarsal head...
, hammer toe
Hammer toe
A hammer toe or contracted toe is a deformity of the proximal interphalangeal joint of the second, third, or fourth toe causing it to be permanently bent, resembling a hammer...
s, bunion
Bunion
A bunion is a deformity characterized by lateral deviation of the great toe, often erroneously described as an enlargement of bone or tissue around the joint at the head of the big toe...
s, Morton's neuroma
Morton's neuroma
Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the third and fourth intermetatarsal spaces.This problem is characterised by pain and/or numbness, sometimes relieved by removing footwear.Despite the name, the...
, Plantar Fasciitis
Plantar fasciitis
Plantar fasciitis is a painful inflammatory process of the plantar fascia, the connective tissue on the sole of the foot.Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis. The suffix...
, and general fatigue of the feet.
See also
- Digit ratioDigit ratioThe digit ratio is the ratio of the lengths of different digits or fingers typically measured from the bottom crease where the finger joins the hand to the tip of the finger. It has been suggested by some scientists that the ratio of two digits in particular, the 2nd and 4th , is affected by...
- HalluxHalluxIn tetrapods, the hallux is the innermost toe of the foot. Despite its name it may not be the longest toe on the foot of some individuals...
- List of Mendelian traits in humans
- Foot typeFoot typeFoot type refers to differences in foot structure and shape, as reflected in pronation during heel strike running.Foot type affects the reduction of impact on the foot while walking, jogging, or running...
- OrthoticsOrthoticsOrthotics is a specialty within the medical field concerned with the design, manufacture and application of orthoses. An orthosis is an orthopedic device that supports or corrects the function of a limb or the torso...
- Runner's toe, repetitive injury seen in runners