Morton's toe is the condition of having a first

metatarsal The metatarsal bones, or metatarsus, are a group of five long bones in the foot, located between the tarsal bones of the hind- and mid-foot and the phalanges of the toes. Lacking individual names, the metatarsal bones are numbered from the me ...

which is short in relation to the second metatarsal (see diagram). It is a type of brachymetatarsia. This condition is the result of a premature closing of the

first First or 1st is the ordinal form of the number one (#1). First or 1st may also refer to: *World record, specifically the first instance of a particular achievement Arts and media Music * 1$T, American rapper, singer-songwriter, DJ, and rec ...

metatarsal's growth plate, resulting in a short big toe, giving the second toe the appearance of being long compared to the first toe. The

bones behind the toes are of different lengths, and the relative lengths vary between people. For most feet, a smooth curve can be traced through the joints at the bases of the toes (the metatarsal-phalangeal, or MTP, joints). 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 (as measured from the MTP joint to the tip, including only the toe bones or 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 furthest, or there may be little difference.

Presentation

The most common symptom experienced due to Morton's toe is

callus A callus is an area of thickened and sometimes hardened skin that forms as a response to repeated friction, pressure, or other irritation. Since repeated contact is required, calluses are most often found on the feet and hands, but they may o ...

ing and/or discomfort of the ball of the foot at the base of the second toe. The first metatarsal head (toeward end of the metatarsal, at the base of the big toe) 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 (80-person) study found no statistically significant difference in the frequency of longer second toes between people with and without

ingrown toenails An ingrown nail, also known as onychocryptosis from el, ὄνυξ () 'nail' and () 'hidden', is a common form of nail disease. It is an often painful condition in which the nail grows so that it cuts into one or both sides of the paronychium ...

, 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

toe box The toe box is the section of footwear that surrounds the toes on closed-toe shoes. Toe boxes that are too tight can cause injuries and foot deformities, whereas wider toe boxes may be used to treat or prevent common foot conditions such as Mor ...

can also cause

hammer toe A hammer toe or contracted toe is a deformity of the muscles and ligaments of the proximal interphalangeal joint of the second, third, fourth, or fifth toe causing it to be bent, resembling a hammer. In the early stage a flexible hammertoe is ...

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 Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve, most commonly of the second and third intermetatarsal spaces (between the second/third and third/fourth metatarsal heads; the first is of the big toe), which results in th ...

. Wide shoes are recommended.

Treatment

Asymptomatic 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

proprioceptive Proprioception ( ), also referred to as kinaesthesia (or kinesthesia), is the sense of self-movement, force, and body position. It is sometimes described as the "sixth sense". Proprioception is mediated by proprioceptors, mechanosensory neurons ...

orthotics Orthotics ( el, Ορθός, translit=ortho, lit=to straighten, to align) is a medical specialty that focuses on the design and application of orthoses, or braces. An is "an externally applied device used to influence the structural and functio ...

can help alleviate numerous problems of the feet such as

metatarsalgia Metatarsalgia, literally metatarsal pain and colloquially known as a stone bruise, is 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. Meta ...

bunion A bunion, also known as hallux valgus, is a deformity of the joint connecting the big toe to the foot. The big toe often bends towards the other toes and the joint becomes red and painful. The onset of bunions is typically gradual. Complicatio ...

plantar fasciitis Plantar fasciitis or plantar heel pain (PHP) is a disorder of the plantar fascia, which is the connective tissue which supports the arch of the foot. It results in pain in the heel and bottom of the foot that is usually most severe with the fi ...

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%.

Etymology

The name derives from American

orthopedic surgeon Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

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

es under the second and third metatarsals. Confusion has arisen from "Morton's foot" being used for a different condition, Morton's metatarsalgia, which affects the space between the bones and is named after Thomas George Morton (1835–1903).

Culture

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 In biology, an atavism is a modification of a biological structure whereby an ancestral genetic trait reappears after having been lost through evolutionary change in previous generations. Atavisms can occur in several ways; one of which is whe ...

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 The sculpture of ancient Greece is the main surviving type of fine ancient Greek art as, with the exception of painted ancient Greek pottery, almost no ancient Greek painting survives. Modern scholarship identifies three major stages in mon ...

, and this persisted as an aesthetic standard through

Roman Roman or Romans most often refers to: *Rome, the capital city of Italy *Ancient Rome, Roman civilization from 8th century BC to 5th century AD *Roman people, the people of ancient Rome *'' Epistle to the Romans'', shortened to ''Romans'', a lette ...

and

Renaissance The Renaissance ( , ) , from , with the same meanings. is a period in European history The history of Europe is traditionally divided into four time periods: prehistoric Europe (prior to about 800 BC), classical antiquity (800 BC to AD ...

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''.

References

Sources

* 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.
"British feet"
''Discover Magazine'', June, 1996, Retrieved June, 2021. * {{DEFAULTSORT:Morton's Toe Foot diseases Skeletal disorders Toes