A very common injury seen in our office involves pain directly under the second metatarsal toe which typically presents in people with a “Morton’s foot”. One third of all people have a second metatarsal or second toe, which is longer than the adjacent big toe. In this foot type, there are often increased pressures to the forefoot at the second metatarsal head and toe exacerbated by running, jumping, and pivoting activities. In time, the second toe may become curled leading to a hammertoe with a red and/or inflamed knuckle on top of the toe. Pain may be present directly to the bottom base of the second toe area, and eventually the tip of the second toe may become lifted from the ground.
Over time, the entire forefoot may hurt and it’s not unusual to start walking in a compensatory manner. Patient’s may not be able to discern exactly where the most severe pain is emanating. A careful and thorough examination in our office pinpoints the area of most pain. X-rays are taken in a weightbearing fashion so that we can see your foot bones as they function and to determine where there may be increased pressure points.
It is not uncommon for one to also injure the second toe area during pivoting sports such as tennis, golf, and/or basketball. Treatment for this condition starts with ice, anti-inflammatory medications, and wearing an extra cushioned shoe or pads on the bottom of the foot. A corticosteroid injection under direct fluoroscopic (x-ray) visualization in our office often provides relief. Custom orthotics are indicated for this condition, especially in the earlier stages.
If this structural abnormality cannot be alleviated by the aforementioned conservative methods, then surgical shortening of the second metatarsal and/or toe will realign the joint. We perform these specialized surgeries and in addition to fixing the bone, a tendon transfer and/or tendon lengthening will help to straight the joint. Patients have healed extremely well from these procedures and are soon back enjoying a full array of activities. Should you or anyone you know suffer from pains of a Morton’s foot injury, please do not hesitate to contact our office.
Written by Richard T. Braver, DPM, FACFAS