I Have A Long Second Toe!

If your second toe is longer than your first toe, you have a type of foot called Morton's toe, or Greek foot. It is a form of brachymetatarsia, which promotes an anterior position of the second toe in relation to the big toe. This deformity may or may not result in the second toe extending past the big toe.
The name Morton's toe was given by American orthopedic surgeon Dudley Joy Morton, who included it as part of the Morton's triad: a short first metatarsal bone, a hypermobile first metatarsal segment, and calluses underneath the second and third toes. Morton's toe can also be confused with Morton's neuroma, which involves a nerve between the third and fourth toes. Morton harkened back to prehistoric humans, who probably used their toes for grasping.
The Greeks believed this type of foot to be beautiful, and it appears in sculptures and art. As well, it persisted as an aesthetic standard through Roman, Renaissance, even modern times- the Statue of Liberty has a Greek foot!
Morton's toe is a common foot type, but can be considered a deformity as well. The symptoms associated with Morton's toe include discomfort and callusing along the top of the second toe. This is because the big toe would normally bear the weight of walking, but these forces are transferred to the second toe because of its length and position. With shoes it can be a problem when trying to fit a shoe to the second toe.
Morton's toe affects 20% of the population, but 80% of people with it have foot pain. The reason for this high ratio is because of excessive pronation (weight bearing). Excessive pronation causes the leg to be shortened or lengthened, and the leg is rotated internally. Other problems associated with Morton's toe are: metatarsalgia, hammertoes, mallet toes, bunions, Morton's neuroma, and heel pain.
Treatment is often orthotics to realign the foot to its proper position and relieve some of the pressure from the second toe.
If you have a Morton's toe and are experiencing pain, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Related articles

• My Second Toe Hurts: Capsulitis
• Bunching in My Foot: Morton's Neuroma

Mallet Toes: Not Something You Hammer With

A mallet toe occurs when the joint at the end of the toe will not straighten. This is different from a hammertoe because in a hammertoe, any joint can be affected. Excessive rubbing of the deformity against the top of a shoe will lead to the development of a corn and pain. The tip of the toe is often turned down against the shoe, causing pressure and discomfort. Those with mallet toes are often embarrassed by this deformity because it can stick out like a sore thumb. When left untreated, the pigment of the skin on the mallet toe can become dark and circular.
Causes of mallet toes include:

• If you are on your feet all day. 
• Participate in sports regularly.
• Have arthritis
• Have nerve damage in your back, leg, or foot.
• Have very high or very flat arches.
• Wear shoes that don't fit
• Were born with a toe deformity.

Other factors include poor circulation, diabetes, edema, and wearing non-leather shoes. Complications of the mallet toe can lead to puss, infection, and swelling, as well as a change in gait pattern because of pain.
Conservative treatments for mallet toes include:

• Wearing shoes with a large, square toe box.
• A toe crest or buttress pad.
• Gel toe caps or shields.

If your mallet toe is causing significant pain or has progressed to an infection, call a podiatrist to make an appointment. Surgical treatments a podiatrist may try are:

• Amputation of the tip of the toe (only if gangrene or severe infection is present).
• Joint fusion of the toe.
• Partial bone/joint removal.
• Flexor tenotomy or lengthening.

If you have a mallet toe, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Related articles

• What Are Hammertoes?

Overlapping and Underlapping Toes

Toe deformities are common in children. These conditions are generally congenital, with one or both parents with these problems. Toe issues are typically present at birth and will become worse over time. Unlike children who are "pigeon-toed", children rarely outgrow this deformity.
In infancy, toe deformities are not usually a sign of another condition. For parents, it's usually a cosmetic issue. But as the child grows, the toes transform from flexible to rigid and become symptomatic of another condition. Many toe deformities will respond to conservative treatment. Traditional treatment has been digital splitting and exercises, but those often do not lead to good outcomes. As the deformities progresses and the toes become more rigid, surgery is generally the only option.

Underlapping toes can be seen in both children and adults and typically affects the fourth and fifth toes. A special type of underlapping toes is called congenital curly toes, and is common among families. Toes three, four, and five may be affected.
The cause of the deformity is unknown, but may be due to an imbalance in muscle strength of the small muscles of the foot. Combined with a small abnormality in the placement of the joints of the foot below the ankle joint called the subtalar joint, it creates a pulling of the ligaments in the toes, causing them to curl. Weight bearing increases the deformity and the folding of the toes results in the formation of callus on the edge of the toe. Tight fitting shoes aggravate this condition.
Treatment depends on the age of the patient, degree of the deformity, and symptoms. When symptoms are minimal, most podiatrists will recommend waiting and seeing how the condition progresses. If surgery is required, the degree of the deformity determines the procedure. A flexible toe will only require a simple release of the tendon, but a rigid toe may necessitate the removal of part of the bone.
Overlapping toes are identified by one toe that lies on top of another toe. The fifth toe is most often affected, but the second toe can be as well. The cause of this deformity is not known as well, although it is speculated that the position of the fetus in the womb during development is a potential reason. Sometimes overlapping toes are seen in families.
Treatment for overlapping toes depends on how quickly the condition is diagnosed. For infants, passive stretching and adhesive taping is commonly prescribed. This treatment can take 6 to 12 weeks and recurrence of the deformity is likely. Like underlapping toes, this problem will rarely correct itself. Occasionally as the individual grows, the deformity will go away. If surgery is required, a skin plasty is required to release the contracture of the skin associated with the toe. A tendon release and release of the soft tissue around the joint at the base of the toe may also occur. Cases that are severe may require the toe to be held in place with a pin. The pin exits the tip of the toe and may be left in place for up to three weeks. During recuperation the patient must limit their activities and wear a surgical shoe or removable cast. Excessive movement will greatly affect the outcome of how the toe looks. Following removal of the pin splinting of the toe may be required for another two to three weeks.
If you have underlapping or overlapping toes, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Related articles

• What Are Hammertoes?
• My Second Toe Hurts: Capsulitis
• Can I Have A Bunion On the Outside Of My Foot?

My Toes Are Webbed Like A Duck!

Webbed toes are when two or more toes are fused together. We typically think of animals, like ducks and frogs to have webbed toes, not humans. During our fetal development, we all have fingers and toes that are webbed. At six to eight weeks of development, an enzyme dissolves the tissues between our digits. But 1 in every 2,000 births results in webbed toes. Webbed toes can also be called duck toes, twin toes, or tiger toes.
The most commonly webbed toes are the second and third toes, and there are six types of webbed toes:

• Simple. Adjacent toes are joined by soft tissue and skin only.
• Complex. Bones of the toes are fused together. This is very rare.
• Complete. The skin joins the toes from top to bottom. 
• Incomplete. The skin is joined partially by skin, usually only to the first joint. 
• Fenestrated. Skin is joined for most of the toe, but there is a gap in the middle. 
• Polysyndactyl. There is an extra digit webbed to an adjacent digit.

This condition will not impair a person's ability to walk, run, jump, or swim, however many feel embarrassed or experience low self esteem.
The cause of webbed toes is unknown. Some people used to believe it was an inherited trait, but sometimes only one person in the family would have webbed toes. Studies suggest a woman's nutritional intake during early gestation and smoking during pregnancy may contribute to this deformity. Webbed toes are also associated with the following conditions:

• Down's Syndrome
• Apert's Syndrome
• Poland Syndrome
• Holt-Oram Syndrome
• Carpenter's Syndrome
• Edward's Syndrome
• Fetal hydantoin effect
• Miller Syndrome
• Pfeiffer Syndrome
• Amniotic Band Syndrome
• Smith-Lemli-Optiz Syndrome
• Aarskog-Scott Syndrome
• Bardet-Beidl Syndrome
• Cornelia de Lange Syndrome
• Familial syndactyl
• Timothy Syndrome

Diagnosis may occur even before birth with a sonogram, or at birth. Additional symptoms indicate there is an underlying syndrome.
Webbed toes can be separated surgically, even though this condition does not cause any health problems (unless there is an underlying condition). Your doctor will use a skin graft from your thigh, which fill in the missing skin, to surgically separate your toes. Results will vary on the severity of the webbing and the underlying bone structure. Surgery will begin with general anesthesia and the surgeon marking off the areas that will be repaired. The procedure can last from 2 to 4 hours, depending on the severity of the condition. Most patients are required to stay in the hospital for up to 2 days after surgery. Many patients experience swelling and bruising, but that is normal. Pain medication will be prescribed to deal with the pain and discomfort. Once you are released from the hospital you will have to keep your bandages clean and dry for up to 3 weeks. Skin grafts can be very dry, and using lotion will help moisturize the area.
Complications of the surgery may include scarring and webbing growing back. There may also be post-operative swelling, severe pain, numbness, bluish discoloration, and tingling toes. If you experience any of these symptoms, call your podiatrist right away. Other complications include:

• Skin graft damage, which may darken over time.
• Breathing problems
• Sore throat from tubation
• Excessive bleeding
• Infection
• Bad reaction to medications
• May need second surgery

If you have webbed toes, consider asking your podiatrist the following questions:

• Will I pass this on to my children?
• Do you recommend surgery?
• What are the risks?
• What tests should I anticipate?
• Are there non-surgical treatment options?
• What nutrients reduce the risk of my child having webbed toes?

If your child is born with webbed toes, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

My Child's Toes Turn Inward

Have you noticed when your child walks or runs, their toes turn inward instead of pointing straight ahead? This is called intoeing, or more commonly known as being "pigeon-toed".
You may first notice this when your child begins to walk, but a child of any age may show signs of intoeing. Severe cases of intoeing will cause the child to stumble or trip as they catch their toes on the other heel. There is not usually pain associated with this foot deformity, nor does it lead to foot arthritis, as is popularly speculated.
For the majority of children under the age of 8, this condition will correct itself on its own, without the use of braces, casts, surgery, or other special treatment. Children who are suffering from pain from their intoeing, or there are signs of swelling or a limp should be seen by a podiatrist.
The cause of intoeing typically comes from an alignment issue from some area of the body. Three common conditions associated with intoeing are:

• Curved foot
• Twisted shin
• Twisted thighbone

These conditions often run in families, but can occur on their own or in conjunction with other orthopedic problems. Prevention is not an option since those conditions occur from developmental or congenital disorders.

Curved foot, or metatarsus adductus, is when a child's feet bend inward from the middle part of the foot to the toes. This is different than clubfoot, but severe cases may look like one. Some cases may be mild and flexible, but others may be severe and stiff. Curved foot typically improves on its own over the first 4 to 6 months of a child's life. Babies over 6 months who still have this condition, which may have progressed, may be treated with casts or special shoes. Surgery to correct the deformity is rarely used.

Twisted shin, or tibial torsion, is when the child's lower leg (tibia) twists inward. This can occur before birth, as the legs rotate to fit in the tight space of the womb. After birth, most infant's legs rotate to align properly. When the lower leg remains turned in, twisted shin occurs. As the child begins to walk, their feet turn inward because the tibia in the lower leg points the foot inward. The tibia can untwist as the bone grows taller. Tibial torsion almost always improves on its own, usually before the child goes to school. Splints, special shoes, and exercise programs do not work. If the child is 8 to 10 years old, with a severe walking problem or limp and still has this condition, surgery may be required to reset the bone.

Twisted thighbone, or femoral anteversion, is when the child's thighbone turns inward. It will appear most obvious when the child is 5 or 6 years old. The top part of the thighbone, near the hip, has an increased twist, which allows the hip to turn in more than it should. If you watch your child walk, both their toes and their knees will turn in. When sitting, children with this condition are often in a "W" position, with their knees bent and their feet flared out behind them. Most cases of twisted thighbone correct themselves, often spontaneously. Like tibial torsion, special shoes, braces, and exercises do not help. Surgery is not usually considered unless the child is 9 or 10 years old and the deformity causes tripping and an unsightly gait. Surgery involves cutting the femur and rotating it to the correct position.
If your child is suffering from intoeing, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
Visit our website, like our page on Facebook, and follow my tweets on Twitter.

Related articles

• My Toes Are Turning Outward. What's Wrong?