| Morton's toe | |
|---|---|
| Other names | Morton's syndrome[1] Greek toe[2] |
 | |
| A Morton's toe that is so severe the second and third toe appear longer than the first toe. | |
 | |
| Dorsal surface of a right foot with Morton's toe (left image) and without (right image). The dashed line highlights joint position. Metatarsals in yellow. | |
| Specialty | Orthopedic |
| Symptoms | Abig toe that isshort compared to the second toe |
| Usual onset | Birth |
| Duration | Life-long |
| Frequency | 22% of the world population[3] |
Morton's toe, also known asGreek toe, is the condition of having a firstmetatarsal bone that is shorter than the second metatarsal (see diagram). It is a type ofbrachymetatarsia.[1] This condition is the result of a premature closing of thefirst metatarsal's growth plate, resulting in a short big toe, giving the second toe the appearance of being long compared to the first toe.[medical citation needed]
Themetatarsal 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 (themetatarsal-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 orphalanges), 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.
The most common symptom experienced due to Morton's toe iscallusing 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.[4]
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[5] found no statistically significant difference in the frequency of longer second toes between people with and withoutingrown toenails, but tight and ill-fitting shoes are generally considered to increase the risk of ingrown toenails,[5][6] and shoes are often too tight on the toes.[7] A tight shoetoe box can also causehammer toes.[8][9]
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 ofMorton's neuroma. Wide shoes are recommended.[medical citation needed]
Asymptomatic anatomical variations in feet generally do not need treatment.[10] Conservative treatment for foot pain with Morton's toe may involve exercises[11] or placing a flexible pad under the first toe and metatarsal;[4] an early version of the latter treatment was once patented by Dudley Joy Morton.[12] Restoring the Morton's toe to normal function withproprioceptiveorthotics can help alleviate numerous problems of the feet such asmetatarsalgia,hammer toes,bunions,Morton's neuroma,plantar fasciitis and general fatigue of the feet.[medical citation needed] Rare cases of disabling pain are sometimes treated surgically.
Morton's toe is a minority variant of foot shape. Its recorded prevalence varies in different populations, with estimates from 2.95% to 22%.[10][5] A study by theBulgarian Academy of Sciences found that it is far more prevalent among Bulgarians.[13] Another study on theIdoma people of Nigeria found almost a third of people have it.[14]
The name derives fromAmericanorthopedic surgeonDudley Joy Morton (1884–1960),[15] who originally described it as part ofMorton's triad, also known asMorton's syndrome orMorton's foot syndrome.[1] It is a congenital short first metatarsal bone, ahypermobile first metatarsal segment, andcalluses 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 afterThomas George Morton (1835–1903).[16]
Morton's toe, especially the second-toe-is-longer versions, has a long association with disputed anthropological and ethnic interpretations. Morton called itMetatarsus atavicus, considering it anatavism 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).[17]
It was an idealized form inGreek sculpture (hence the common name "Greek toe"; modern Greeks have an increased prevalence of Greek foot),[18] and this persisted as an aesthetic standard throughRoman andRenaissance periods and later on inneo-classical works such as on theStatue of Liberty which has toes of this proportion.[19] Some famous Classical and Renaissance art works featuring Morton's toe includeBoxer at Rest,The Birth of Venus,Laocoön and His Sons andDiana of Versailles.[20][21][22]
There are also associations found withinCeltic groups. The French call it commonlypied grec (just as the Italians call itpiede greco, both "Greek foot") but sometimespied ancestral orpied deNéanderthal.[17]
