Morton's toe

File:Morton's foot comparison.svg

Dorsal surface of a right foot with (left) and without (right) Morton's toe, with dashed line to highlight joint position.

File:Photo of Morton's Toe.jpg

In some people with Morton's toe, the second toe is clearly longer than the big toe.

Morton's toe (or Morton's foot, Greek foot, "Royal toe", "Turkey toe", "LaMay toe", "Sheppard's toe", Morton's syndrome, long toe, boss toe) is the condition of a shortened first metatarsal in relation to the second metatarsal. It is a type of brachymetatarsia.

The metatarsal bones behind the toes vary in relative length. For most feet, a smooth curve can be traced through the joints at the bases of the toes. 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 joint at the base of the second toe (the second metatarsal-phalangeal, or MTP, joint) farther forward.

If the big toe and the second toe are the same length (as measured from the MPT joint to the tip, including only the 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 farthest, or there may be little difference, as shown in the X-ray.

File:Mortons Toe XRay.jpg

X-Ray photograph of feet exhibiting Morton's toe.

History

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 calluses under the second and third metatarsals.

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.

Effects

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 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. 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 nail problems such as the curving of the nail.

Cultural associations

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.

Musculoskeletal dysfunction

Janet G. Travell, 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 around 10% 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:

1. The leg is functionally shortened or lengthened.
2. The leg is rotated internally.

Just one 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.

Treatment

Conservative treatment for foot pain with Morton's toe may involve placing a flexible pad under the first toe and metatarsal; an early version of this treatment was once patented by Dudley Joy Morton. 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.

See also

• Digit ratio
• List of Mendelian traits in humans
• Foot type
• Runner's toe, repetitive injury seen in runners

References

• Morton, D. J. "Metatarsus atavicus: the identification of a distinct type of foot disorder", The Journal of Bone and Joint Surgery, Boston, 1927, 9: 531-544.
• Toes, relative lengths of first and second Online Mendelian Inheritance in Man.
• EFORT – European Federation of National Associations of Orthopaedics and Traumatology: Scientific Library: Concepts of the human foot in mythology, art and surgery, John Kirkup, EFORT (Bulletin of European Orthopaedics), #11, Nov. 1999.
• www.painontopoffoottalk.com List of foot pain causing from medicine student.
• "British feet" Discover Magazine, June, 1996, Retrieved July, 2006.