In today’s blog I thought I’d talk about one of the most common conditions I see as a Podiatrist – the long second toe – aka Morton’s Foot or Morton’s Toe.
Although I hear my share of foot myths, I think this topic probably takes 1st place for the most creative misconceptions around foot function. From “you can trip over a Morton’s Toe” to “Morton’s Toe causes you to twist out of your push-off” – I think it’s time we put some clarity on this topic!
What is Morton’s Foot or Morton’s Toe?
A Morton’s Toe is a long second toe, relative to the great toe.
This long 2nd toe is actually not caused by the toe being long – but rather the metatarsal bone being long. If we look at a foot Xray there is what is referred to as a metatarsal parabola. The normal metatarsal parabola is 2nd metatarsal longest, followed by the 1st and 3rd metatarsal, then 4th and 5th.
In a Morton’s Foot, the Xray may look more like below. Note the large difference between the 2nd metatarsal length and the 1st metatarsal length.
Biomechanical Impact of Morton’s Foot
When we consider the biomechanical impact of having a long 2nd toe (or rather a long 2nd metatarsal), we need to think about forces going through the foot. It is the transfer of forces and distribution of these forces that relates to proper foot function.
Any shift in pressure or forces and you get foot pain and dysfunction.
Impact #1 – Metatarsal length
When we have an excessively long 2nd metatarsal (relative to the 1st metatarsal) there are increased forces going through the 2nd metatarsal and 2nd metatarsal phalangeal joint (MPJ). It’s important to mention that the 2nd metatarsal and 2nd MPJ take the highest forces anyways in the foot (as it is the midline of the foot) however the presence of a Morton’s Foot increases these forces even more.
This means that the client is susceptible to stress fractures of the 2nd metatarsal (think about your runners!) as well as to 2nd MPJ sprains / capsulitis.
Impact #2 – Toe length and footwear
When we have a longer 2nd toe but fit our shoes to the length of the great toe, we are obviously going to experience jamming of the 2nd digit into the end of the shoe.
This repetitive jamming of the 2nd toe can cause a buckling or hammering of the toe, as well as micro-trauma to the nail bed. (If you have ever seen a runners or dancers foot with the black 2nd toe nail you will know exactly what I mean.)
Hammering of the 2nd digit causes what is called retrograde pressure or forces that transmit straight down to the just under the 2nd metatarsal head. This can be very painful especially if clients also have a callus under the ball of the foot. Remember that calluses form as a direct relation to pressure or excess forces.
Impact #3 – Lack of toe purchase
As the hammering of the 2nd digit continues to increase, so does the retrograde pressure to the 2nd MPJ. There is a secondary inflammatory response and injury that can occur to the ligament, aka plantar plate, of the 2nd MPJ. The plantar plate is the structure that is the primary stabilizer of the 2nd MPJ.
As this plantar plate continues to get stressed it can eventually tear leading to instability in the 2nd MPJ and the toe begin to lose purchase or contact with the ground. This dorsal subluxation or drift of the 2nd digit further increases the retrograde pressure as described above.
Eventually the pain can be so great that the client requires injections or surgery.
Functional Impact of Morton’s Foot
So what can you do as a health and fitness professional working with a client or athlete who has Morton’s Foot? I think the first step is to understand the impact of this foot type and to know that it does not cause them to “trip” or “twist out of their push-off” but rather will alter their force distribution.
Tip #1 – Buddy splinting can help stabilize the 2nd MPJ
Since these clients are susceptible to 2nd MPJ sprains and instability you can preemptively help stabilize the joint by buddy splinting the 2nd to the 3rd digit. I often recommend this to my patients we are experiencing early symptoms of 2nd MPJ instability and are runners, do a lot of yoga, wear high heels etc.
Tip #2 – Size shoes to the longest toe
Since jamming of the 2nd toe in footwear is one of the biggest causes of hammering and retrograde pressure in the Morton’s Foot, guide your client to properly fitted shoes. Size shoes to the 2nd digit if possible and if excessive sliding occurs use lambs wool at the front of the shoe to make up for the size difference.
Tip #3 – Consider dispersion pads in footwear or when barefoot
If the client is experiencing pain under the metatarsal head, U-pads or orthotics with dispersion pads in them are a great option. Outside of surgery the only way to shift forces going through the foot is really only through paddings and inserts. I have made dispersions pads for my barefoot-friendly patients which can easily go onto their foot or into their minimal footwear.
To learn more great tips on foot function and barefoot science, please visit http://www.ebfafitness.com
Are you barefoot strong?
Interesting article especially the effects of Morton foot.
Thanks.
Nice article. Thank you. I’m in Colorado. Would you recommend someone here that makes dispersion pads as I’m barefoot all the time? What’s the approximate cost of something like this? How long do the pads typically last if one is bare foot all day?
Have a happy and peaceful day. Jeff
Hello Jeff. Thank you for reading the article. You can actually purchase dispersion pads online – it is called a U-pad.
http://www.performancefoot.com/208-u-shaped-pad-felt-foam.html
I hope this helps!
Hello, thank you for this article. I have read other (disturbing) articles on the internet about Morton’s Toe that says that the most stable, normal and ideal metatarsal ratio is the first longest, then the second etc. But I have also seen podiatry information about the metatarsal parabola saying that normally it is the 2nd that is longest followed by the first/third. Could you please clarify whether having a 2nd metatarsal slightly longer than the first is really a problem that justifies surgery and treatment? Those that say that the first metatarsal should be longest argue that a longer second metatarsal creates an unstable base with only 2 points of balance instead of a 3 pointed tripod shape. Thank you.
Thank you for your comment and reading the Barefoot Strong Blog!
The correct metatarsal length relationship you want for proper force distribution is 2nd longest, following by 1st / 3rd equal then 4th / 5th.
When the 1st metatarsal is too long it can create jamming at the 1st MPJ. If the 2nd is excessively longer than the 1st / 3rd then this also increases the risk of injury. So yes 2nd longest but not too long. I hope this helps clarify! Dr Splichal
That was a very fast reply! Thank you so much Dr Splichal for this clear and reassuring information – I spent all day today looking at my feet in a whole new light as a possible cause of pain and suffering. My second metatarsal is only slightly longer than the first so I am relieved. I will keep reading this great website, thanks again – Steph
This is a nice article presented in an orderly manner and simple enough so non-medical people such as myself can fully see the implications of Mortons Toe. Thanks to improper shoe fittings and multiple orthodics to fix everything but the problem by my pediatrician circa 1970, I too had my to jammed into shoes. My second toes were never commented on though.The end result being the nail of my second toe tends to wrap around the end of the toe. It’s not a problem as long as I’m regular with the clippers. I’m curious though since my second toe is about 3/4″ longer than my first toe and my third toe is slightly longer than my first toe. To date I haven’t had any of the issues that seem to plague people with this. I have found though that ill fitting shoes (regardless of cost) cause me more problems than anything else. The Merrell brand of shoes I have found to be the best fitting ones and most comfortable ones on me. I have had no problems with foot pain since I made the switch.
Thanks again for the article.
Do black people develop Mortons toe?
Hello Jerome – of course – all feet have the exact same anatomy across all races. Shoes and footwear can predispose you to neuromas and the predilection is a little higher in women but I still treat many men with neuromas. Dr Splichal
Thank you for this enlightening article. I have Mortons toe, and wonder why no podiatrist or chiropodist Ive gone to hasn’t even noticed. Now there s a problem, and no expert in sight. I have to wear cirrhotics which affect the pressure of toe to leather. I have tried a shoe size larger…necessitating thicker socks. I wonder if cutting a pair of gel insoles and using the top parts to close the gap between toe and orthodontic to avoid sliding forward in the shoe, which means toe jamming. There are no feet experts where I live
Great Information guys about Morton’s toe. Excellent blog share with us and I like that kind of great blog.
Good article. I am 65 and LIKE my feet. I take great exception to the title, “disorder.” It is not abnormal, but simply a variant of the norm. Cultures without restrictive shoes probably have few problems. Many old world statues have Morton’s toe feet. About 20% of folks world-wide have such toes, and, if we are to believe archaeology, have for thousands of years.
Hello Christi – yes exactly it is a variant of the norm. This article never said everyone with a long 2nd toe has a “disorder”. There are certain stressors that are placed on the 2nd MPJ in those with a Morton’s Toe / Foot. That was the central focus of this article. Sorry that you missed that aspect. Dr Splichal