Morton's toe is the condition of having a first metatarsal which is short in relation to the second metatarsal. It is a type of brachymetatarsia. 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. 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, 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
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. 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 study 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, and shoes are often too tight on the toes. A tight shoe toebox can also cause hammertoes.
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
anatomical variations in feet generally do not need treatment. Conservative treatment for foot pain with Morton's toe may involve exercises or placing a flexible pad under the first toe and metatarsal; an early version of the latter treatment was once patented by Dudley Joy Morton. Restoring the Morton's toe to normal function with proprioceptiveorthotics 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%.
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. It was an idealized form in Greek sculpture, and this persisted as an aesthetic standard through Roman and Renaissance periods and later. There are also associations found within Celtic groups. The French call it commonly pied grec but sometimes pied ancestral or pied de Néanderthal.
