Crossover Toe Deformity

Dislocation of the second toe usually happens slowly, where the toe drifts and, eventually, overlaps the big toe. It often occurs concurrently to a bunion. The cause is a tear in the Plantar Plate, the tough fibrocartilagenous thickening which attaches the toes to the pad that covers the joint at the base of the toes. Its main function is to resist the force of toe off.

This deformity can happen due to chronic inflammation or acute trauma to the second metatarsophalangeal joint (the area of attachment of the bones of the toes to the base of the toes called metatarsal heads). Progressive inflammation in the MTP joint leads to rupture of the plantar plate and collateral ligaments. In fact, any structural of functional deformity that results in inflammation of the plantar plate can result in joint instability.

Localized inflammation and pain of the 2nd MTP joint are early signs of strain of the plantar plate. When weight-bearing the toe may not shift sideways and may not touch the ground, which will cause more pressure on the bottom part of the metatarsal heads leading to bone bruise, callusing, and pain. Eventually, the pressure on the misaligned joint may cause arthritis. The biomechanics and functionality will also be altered.

Swelling around the base of the toe is a common symptom, as well as the distinct change in the position of the toe during the previous weeks or months. An X-ray as well as a physical examination will confirm the diagnosis. Common treatments include pain relief with NSAID medications, orthotics, and accommodative padding, as well as avoidance of high-heeled shoes. Taping is effective if the toe is deviated but not if it is dislocated. However, prolonged taping may cause swelling and/or an ulcer to form.

Corticosteroid injection in the joint is usually not recommended because it may weaken an already compromised plantar plate. Surgical removal of the toe will cause the 3rd toe to drift to the place of the missing toe so it’s not often recommended.

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