Often, one notices that the second toe of some people is longer than the great toe. People say different things for it. Many of them say that it implies that the owner of such a longer second toe is a dominant, creative, energetic person in real life and very ambitious and peace and happiness-loving. But no one has tried to understand the reason, science, medicine and problems of having such a toe. It is called as Morton’s toe or Greek foot.
What is a Greek foot?
Many people in the world have a longer second toe of the foot. Such feature may be on one side or in both the feet. It is called Morton’s toe or Greek foot. The other names for it are Morton’s foot or royal toe. But the reason is not the second toe is longer but the fact is that the first metatarsal below the great toe is shorter. Thus it is not due to the faulty phalanges but due to the difference in height of the metatarsals. Since the second metatarsal is relatively longer than the first metatarsal, the joint at the base of the second toe (second metatarso-phalangeal joint) is pushed further forward and gives a feel of a longer second toe. Thus the actual problem is that of brachy-metatarsia.
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This occurs because the growth of the first metatarsal bone is affected due to congenital or acquired factors. Its physis (growing end) closes prematurely and this leads to it remaining shorter than the second metatarsal. Such a shortening or brachymetatarsia can affect any metatarsal and when the first metatarsal is affected, it is Morton’s toe or Morton’s syndrome. The term is a misnomer because the toe is actually not affected but its metatarsal is affected.
The origin of the name Morton’s toe and its epidemiology
American orthpedician Dudley Joy Morton (1884-1960) originally described this condition of the foot. It was part of a triad in his patients of a congenital short first metatarsal bone, a hypermobile first metatarsal segment and formation of calluses under the second and third metatarsals. This was called Morton’s triad and the condition Morton’s syndrome. And the word Greek came to be associated with this syndrome because it was commonly found in sculptures of Greek culture. It was said to mean beautiful and a perfect harmony in aesthetics. The alternative foot where the second toe was shorter is called Roman or Egyptian foot because Egyptians focused more on scale and accuracy rather than on aesthetics.
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| Statue of Liberty (Source: Daily Mail UK) |
Tachdjian revealed in his studies that the first metatarsal is the most affected by this shortening. Its incidence was around 1 in 10000. But some feel that the 4th metatarsal is more commonly shortened. More studies come from Japan and there the incidence of this condition was found to be 1 in 1820-4586. The studies also revealed that it was bilateral in 72% of the cases. Females have this condition more commonly (female: male ratio of 25:1). In Nigeria, it was seen that Morton’s toe was noticed in 35.3% of the population studied. But males in this study had a slightly higher incidence of the toe. And this study also concluded that the inheritance pattern was a complex one and not based on simple dominant-recessive pattern. In the USA, it was seen in 42.2% of college goers.
Causes of shortening
Idiopathic congenital-hereditary early epiphyseal plate closure, association with Down’s syndrome, Turner’s syndrome, Larsen’s syndrome, Albright’s syndrome, pseudohypoparathyroidism, pseudohyperparathyroidism, polio, dystrophic dysplasia, multiple epiphyseal dysplasia, myositis ossificans.
Acquired-post-trauma, neurotrophic disorder, ill-effects of radiation, post-surgical resection of the metatarsal for any reason, infection of heard or osteochondrosis.
Significance of Morton’s toe
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| Morton’s toe (Source: Pinterest) |
There are a lot of myths associated with such a toe. It is believed that people with Morton’s toe are of a dominating personality and have good leadership qualities. They are extrovert and of Greek descent. It should be noted that the Statue of Liberty and Michaelangelo’s David both have longer second toe. A 2004 study found that professional athletes have it more commonly.
But the truth is there is a scientific reason behind it and due to this the dynamics of the foot changes leading to certain medical problems in those who have this toe. There is hypermobility of the first metatarsal bone and hence instability in that part of the foot results. This leads to hyper-pronation (inward movement) while walking and the foot is unable to form a rigid lever to propel onself forward. This causes a pressure to build up under the second toe and calluses ensue. Other areas of the foot are also strained and there can be bunions, heel spurs, plantar fasciitis, corns, calluses, in-growing of toe nails, and several other foot issues.
It also leads to foot pain at various points. There can be metatarsalgia or ball of foot pain, Morton’s neuroma, stress fractures of metatarsals, claw and mallet or hammer toes. The condition can also cause lower leg pains such as ankle pain, shint splints, tightness and soreness of calf muscles, knee pain, tightening of iliotibial bands on side of the thighs, chondromalacia in knee area, fractures of the menisci, ACL tears, sciatic nerve pain, and arthritis of other joints. The problem can extend upwards and cause scioliosis (sideways deviation) or kyphosis (forward bending) of spine, sacroiliac joint pain, piriformis syndrome, low back pain, upper back and shoulder pains, and also neck pain.
Conservative and surgical therapies are available for Morton’s tow if it causes problems. But surgery is a lost resort. Orthotic devices, taping, and metatarsal pads are tried first.
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