Morton’s Toe and Plantar Fasciitis

Morton’s toe is the common term for a condition where the second toe appears longer than the first or big toe.

Also referred to as Morton’s syndrome or Long Toe, it is the 1st metatarsal (big toe bone) which is indeed shorter than the second.  The smaller joint of the second toe, therefore lays ahead of the first and as such is forced to bear the weight when walking.

Correct human gait sees the weight placed toward the outer aspect of the heel with the foot rolling in during walking to place the weight under the stronger 1st Metatarsal or big toe as we “toe off”.

The big toe can seem insignificant but a human being will struggle to walk without one.  A thumb is often removed and used as a replacement when this toe is lost through injury or disease.

Plantar Fasciitis

The plantar fascia is attached to the head of the 1st metatarsal, (big toe) and any problem affecting the big toe and it’s joints will have an effect on the windlass or spring mechanism of the plantar fascia.

Plantar Fasciitis is a common condition in Morton’s Toe patients.

Morton’s Toe Hereditary

Clinically, Morton’s toe is a problematic musculoskeletal condition and in many medical texts is referred to as a disease.  However, this positioning of the first and second toes is common enough to be a normal variant of foot shape and is considered an inherited trait.

If anybody is interested; the term Morton’s Toe, derives from an American 19th Century orthopedic surgeon, Dudley Joy Morton.

He described the condition as part of Morton’s triad, Morton’s foot syndrome or Morton’s Principle, in which he refers to it as a congenital (inherited) short first metatarsal bone, with calluses found under the second and third metatarsals and a hypermobile first segment. (A joint which is considered to move well beyond it’s normal range).

Symptoms

• Discomfort in the foot and callusing of the second and third metatarsal head.
• Nail problems – Nails of the second toe often rub on shoes which are designed for a larger big toe.
• Excessive pronation – The foot is forced into a weaker position causing the ankle and arch to roll too far inward.
• Plantar Fasciitis – Caused by undue stresses on the plantar fascia.
• Knee, hip and back pain – Excessive pronation and poor gait causes a functionally shorter leg, this can lead to a musculoskeltal imabalance of joints higher up the chain.  In severe cases, a scoliosis or unnatural sideways curvature of the spine can be found.

Other names for Morton’s toe

Interestingly, there are many other, older names for Morton’s Toe;

Metatarsus Atavicus –  A name given to the condition by Morton himself, considering it to be an evolutionary throwback to grasping prehnesile toes

Greek Toe – Art and statuary from ancient Greece often depicts a longer second toe and was thought to be considered a sign of nobility. This term is also widely used throughout Europe with the French term Pied Grec and the Italian Piede Greco.  Morton’s inherited theory also shows in the lesser used French Pied de Néanderthal and Pied Ancestral.

Roman Toe (Peide Romano) – Roman statuary often carries depictions of a longer second toe.  The Romans were extremely good at absorbing the skills and customs of other countries such as that of the Greeks and Estruscans.  Greek style statuary features strongly in Roman culture.

Treatment of Morton’s toe

• Special orthotics are often required with a customised extension to the first metatarsal to compensate for the shortened toe.
• Treatment of plantar fasciitis or other biomechanically related conditions.
• Soft tissue manipulation is often used to mobilise joints in the foot which have become tightened or strained due to incorrect use.
• Use of footwear which can accommodate the longer second toe.
• Surgery -rarely, surgery is used in extreme cases to shorten the second toe.

More information

Dudley Joy Morton – More about the surgeon and his texts on Morton’s Toe.

Piede Greco / Piede Romano – Italian reference to Morton’s Toe.