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Question for Docs and others

Posted by BGCPed on 8/29/02 at 22:48 (093934)

I read an article in Runners World today. The resident foot expert was answering a question re mortons toe. He said that the answer was to place a horseshoe pad under the second met head in the shoe. He went on to claim that mortons toe is the leading cause of over pronation. Mortons toe is a condition where the first met shaft is shorter or the second toe is longer than the first, also called ballerinas foot.

My question is does anybody know of what study or paper supports this claim? I would think that tight heel cords, ptti, ff varus,low inclination of calcaneous etc could/would contribute more. I also realize this is somewhat of a chicken or the egg question. Some of the points I listed could also be called a result of rather that the cause of.

Just wondered what others thought

Re: Question for Docs and others

Ed Davis, DPM on 8/30/02 at 21:18 (094033)

Dudley Morton wrote a textbook about foot problems, I believe, in 1953. A whole bunch of things got named after him -- Morton's neuroma for example.
The term 'Morton's toe' really has no meaning. Morton basically described a foot type (sometimes more accurately termed the 'Morton's foot type) that basically describes first ray inadequacy. The radiographic signs of first ray inadequacy includes a cleft between the first and second cuneiforms and hypertophy of the shaft of the second metatarsal due to long term transferance of weight away from the first ray. A short first metatarsal is often associated with first ray inadequacy although the first-met cuneiform joint can be hypermobile without first met shortness.
An individual with a short first met has a foot with a big toe that appears short compared to the second toe (the big toe itself may actually be of normal length but it is the additive length of the hallux and first met that provides the appearance of shortness). The hallux (big toe) appearing short, in a Morton's foot type, has sometimes been called a 'Morton's toe.' Nothing like having the expert confuse the issue a bit.

I am not aware of any research that supports his claim. It really can be a 'chicken or egg' argument, as you aptly point out, since a hypermobile first ray leads to decreased retrograde force throught the medial column and thus more pronation but overpronation via equinus can 'break down' the medial column joints and cause first ray inadequacy.
Ed

Re: Question for Docs and others

Ed Davis, DPM on 8/30/02 at 21:18 (094033)

Dudley Morton wrote a textbook about foot problems, I believe, in 1953. A whole bunch of things got named after him -- Morton's neuroma for example.
The term 'Morton's toe' really has no meaning. Morton basically described a foot type (sometimes more accurately termed the 'Morton's foot type) that basically describes first ray inadequacy. The radiographic signs of first ray inadequacy includes a cleft between the first and second cuneiforms and hypertophy of the shaft of the second metatarsal due to long term transferance of weight away from the first ray. A short first metatarsal is often associated with first ray inadequacy although the first-met cuneiform joint can be hypermobile without first met shortness.
An individual with a short first met has a foot with a big toe that appears short compared to the second toe (the big toe itself may actually be of normal length but it is the additive length of the hallux and first met that provides the appearance of shortness). The hallux (big toe) appearing short, in a Morton's foot type, has sometimes been called a 'Morton's toe.' Nothing like having the expert confuse the issue a bit.

I am not aware of any research that supports his claim. It really can be a 'chicken or egg' argument, as you aptly point out, since a hypermobile first ray leads to decreased retrograde force throught the medial column and thus more pronation but overpronation via equinus can 'break down' the medial column joints and cause first ray inadequacy.
Ed