Morton's toe is a common variant shape of the foot that is characterized by the second toe of the foot being the longest. It is also sometimes referred to as Greek foot, Royal toe, Turkey toe, LaMay toe or Sheppard's toe.

As the foot shape changes the distribution of pressure on the foot, people with Morton's foot are more likely to be affected by some foot conditions that may cause pain and other symptoms.

Prevalence

Morton's foot affects approximately 22% of the population. This is in contrast to 69% of the population with Egyptian foot, which is characterized by the big toe being the longest. Squared foot is less common, with approximately 9% of the population with the same length of the great and second toe.

Appearance

The length of the metatarsal bones can vary and in most feet the joints at the base of the toes follow a smooth curve. However, individuals with Morton's foot will have a sharper curve through to the base of the big toe. This is due to the shortened length of the first metatarsal bone in respect to the second metatarsal, which puts the base of the second toe further forward.

Implications

Whichever toe of the foot is the longest is subjected to an increased stress load on the corresponding proximal metatarsal and metatarsal phalangeal joint. Therefore, people with Morton's toe are at an increased risk of injury in the metatarsal of the second toe and resulting symptoms.

This may include the formation of calluses at the base of the second toe on the ball of the foot and associated pain. Some individuals also experience pain in the arch of the foot at the opposite end of the metatarsals bone.

Wearing shoes can also cause problems for individuals with Morton's toe because standardized shoe fits do not allow sufficient space for the additional length of the second toe. As a result, shoes can lead to the presentation of or the worsening of symptoms for people with Morton's toe.

Associated Foot Conditions

People with Morton's toe are more likely to be affected by other conditions of the feet, including:

• Metatarsalgia
• Hammertoes
• Bunions
• Morton's neuroma
• Plantar fasciitis

Management

Morton's toe is simply a variation in the shape of the foot and does not require any specific treatment unless symptoms present. It is helpful for individuals with Morton's toe to be aware of the condition and their susceptibility to injury, to allow them to take the appropriate precautions, such as wearing appropriate shoes.

For patients that report symptoms of pain associated with Morton's toe, physical therapy is the first-line management approach. This may involve the placement of a flexible pad underneath the first toe and metatarsal or exercises to improve the strength and flexibility of the toe muscles. Proprioceptive orthotics can also help to restore Morton's toe to normal function, thus relieving the associated symptoms.

Nomenclature

Morton's toe is named after Dudley Joy Morton (1884-1960), an American orthopedic surgeon who originally described the condition as Morton's triad.

There is some confusion with a distinct condition called Morton's foot, also known as Morton's metatarsalgia, which involves pain due to changes between the metatarsal bones. This condition was named after Thomas George Morton.

References

• https://www.med.unc.edu/medselect/resources/suggested-readings-for-subspecialty-clinics/rheumatology/Foot%20exam%20reivew_11-4-09.pdf
• http://www.foot.com/site/foot-conditions/mortons-toe
• http://www.mortonstoe.com
• http://www.integrativehealthcare.org/mt/archives/2010/12/mortons_toe_one.html

Further Reading

• All Morton's Neuroma Content
• What is Morton’s Neuroma?
• Morton’s Neuroma Treatment
• Causes of Foot Pain

Written by

Yolanda Smith

Yolanda graduated with a Bachelor of Pharmacy at the University of South Australia and has experience working in both Australia and Italy. She is passionate about how medicine, diet and lifestyle affect our health and enjoys helping people understand this. In her spare time she loves to explore the world and learn about new cultures and languages.