Muscle News Vol I.7:  Morton's Foot
Is this Common Foot Dysfunction Wearing Your Knees Out? 
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Sharon SauerIs Your Second Toe Too Long?  In this important issue of Muscle News, we focus on a genetic foot condition that affects approximately 25% of our population.  This common variance in foot structure causes wear and tear on the bones of our feet, contributing to foot deformities such as bunions, bent toes, and calluses.  It is responsible for pain and pressure in our knee joints and instability in our ankles (including recurrent ankle sprains).  It further can affect the posture of our entire spine from tailbone to head.  

Sometimes given the slight misnomer of a "Long Second Toe", this genetic condition is called "Morton's Foot" or "Morton's Toe."  The correction for Morton's Foot
 can be inexpensive and very effective, so please read this article thoroughly if you or anyone you know has problems with their feet, ankles or knees (even low back and neck pain in some cases).
  
Is Your First Toe Too Short?


In normal foot development, the first toe's metatarsal (the bone the toe attaches to, similar to the knuckle of the hand) is the longest of all the toes.  This creates a stable tripod of balance between the heel, the big toe metatarsal and the fifth toe metatarsal (see diagram to left).  In Morton's Foot, the big toe's metatarsal bone genetically develops shorter than the second toe's.  You can often best see this as more webbing between the 2nd and 3rd toes.  As a result, the second toe metatarsal becomes the weight bearing point of the foot, replacing the tripod with a unstable line of pressure from the heel through the second toe.  

To understand the problems this causes, imagine you have taped a pencil to the bottom of your foot starting at your heel and coming out underneath your second toe.  When you walk on that foot, pressure from the pencil will push up on the ball of the second toe (this is why
Morton's Foot sufferers have calluses there).  Your balance will be unstable on the pencil instead of the normal tripod, so you will naturally tend to roll your ankle inward (this is called hyperpronation) or outward (supination, also call bracing because the muscles along the outside of the leg tense and pull the ankle outward to prevent collapsing).  


        
   Hyperpronation              Supination

If you roll inward, you will put the pressure of your body weight on the side of your big toe, setting you up for calluses on the big toe and bunion formation.  You will also put extra pressure on the inside of your knees, causing wear and tear on the knee joint.  If you roll outward, you will put pressure on the outside of your foot and knee, causing problems such as ankle sprains, foot pain, and possible muscle and joint issues on up to your hip and low back. A few quick tests can tell for sure if you have Morton's Foot or not.

*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional.  Please consult your physician to determine whether these self-care tips are appropriate for you.
(3) Self-Tests to Tell if Morton's Foot is Affecting Your Knees:

Follow the instructions below to test whether you have Morton's Foot and whether it might be affecting the health of your knee muscles and joints.

TEST 1:  Toe, Callus & Shoe Inspection

In Morton's Foot, a longer second toe is common, but not always present.  What is important to notice is that the second metatarsal head (the "knuckle" of the foot) is longer than the first.  To see the metatarsal heads, bend your toes downward, exposing the white bony heads of the metatarsals where the toes attach.  As in the picture to the left, the second metatarsal head may protrude out further than the first, indicating Morton's Foot.  Also, take note if there is any sign of the big toe starting to bend toward the second toe, as in the picture shown.  Bunion formation can begin to form as well from this condition.  


Calluses that indicate Morton's foot will develop underneath the second toe metatarsal head, and often also along the inside of the big toe and big toe metatarsal head, the outside of the foot along the fifth metatarsal, and the outside of the heel.  Calluses in any of these areas, especially under the second metatarsal, is a good indication of dysfunction caused by Morton's Foot.


                                  
Shoe wear will indicate Morton's Foot dysfunction, as well.  In a pair of well-worn shoes, you will see either that the foot and ankle have rolled outward (supination) wearing the outside of the shoe, sometimes also referred to as bracing, or they will have collapsed inward (pronation) wearing the inside of the shoe.



TEST 2:  Pronation Test (Taken from www.mortonsfoot.com)

This exercise simulates what happens when you walk, and is an approximation of how much you over pronate.  This is most easily done in front of a long mirror or with the assistance of a friend.


First, stand on a hard surface with your feet comfortably apart, feet straight forward and parallel.  Lean slightly forward and bend your knees so that your hips drop 8-10 inches straight down. Don't squat, and keep your heels on the ground.  

Feel where most of the pressure is under the forefoot.  Is it in the middle, on the outside or inside?

Second, move your knees toward each other until you feel full weight bearing pressure under the ball of the foot behind the big toe. (The pressure should be at least as great as anywhere else under the foot.)

  
Third, with knees in that position, draw an imaginary line from the middle of your knee straight down to the ground.  In a properly aligned foot, the line should fall right upon the big toe.  It the line falls outside or inside of the big toe, it indicates that the second metatarsal is acting like the pencil causing the ankle and foot to rock inward (pronation) or outward (supination).  A lift under the big toe metatarsal (ball of the big toe) is needed to restore normal foot and ankle balance and alignment.  These lifts vary in size, mostly 3 -6 mm, sometimes up to 9 mm, depending on what is indicated by your evaluation.  As a fairly good rule of thumb, here are some guidelines:

6.0 mm:  If the line touches your feet inside (orange) the middle of your big toe, you will most likely need 6 mm lift under the first metatarsal head (ball of the big toe)

3.5 mm:  If the line touches your feet outside (red) the middle of your big toe, you will most likely do well with 3.5 mm first metatarsal lift.  



Test 3:  Knee Palpation

To see if your knees might be affected by Morton's Foot, it is a good idea to press with your finger tips along the inner and outer sides of your thighs and calves to feel for tender spots and taut bands of muscle.  Muscles in these areas will frequently develop myofascial trigger points and dysfuntion due to the strain of supinating (bracing outward) or pronating (collapsing inward).  Supination will often cause a lot of tenderness on the outside of the thigh and lower leg.  Pronation will tend to cause soreness on the inside of the knee.



Fix It Before it Causes Permanent Harm - Simple Self-Care Remedies!

If left uncorrected, the effects of Morton's foot can cause problems with your feet, ankles, knees and on up through the muscle and joints of your body.  Some of these changes, such as bunion formation, can be fairly permanent.  Fortunately, Morton's Foot is easy to correct.  Here are the simple solutions we recommend:

Solution 1:  First Metatarsal Lift

There are some ways to make first metatarsal lifts on your own using easy to purchase supplies.  It can be difficult to get the right amount of lift placed under the right area of the foot.  If you choose this option, here is a link to a do-it-yourself solution provided by an author on trigger point therapy, Amber Davies:  http://www.triggerpointbook.com/mortons.htm


The solution we recommend is an affordable product (~$50) called Posture Control Insoles® made by a leading company in Morton's Foot solutions.  You can visit their site at www.mortonsfoot.com.  We can fit you for these insoles precisely in our office.  If you have Morton's Foot, a pair of posture control insoles is one of the best investments you can make to protect your muscles, joints and your posture.

Solution 2:  Compression

Once the Morton's Foot is corrected with the first metatarsal lift, there may still be a lot of tension and myofascial trigger points in the muscles of the inner and outer thigh and lower leg.  This myofascial dysfunction may cause problems with your knees and ankles if left untreated.  The best tool to treat these general areas is probably the Tiger Tail, which we have used in previous issues of Muscle News.  If you don't have a Tiger Tail, you can try using a rolling pin with a little lighter pressure.

Click here to view larger imageRoll your self-care tool slowly over the outer and inner thigh, as well as over the back and sides of the calf.  When you come across tight bands of muscle or sore spots, pause for 10 seconds (2 slow breaths) and then roll back and forth to tolerance over the spot you compressed.  Repeating this self-care exercise 1-2 times per day will help the muscles break unhealthy patterns of tension caused by Morton's Foot.  You will also be helping your muscles get used to the new healthier posture caused by the first metatarsal lift.

We hope you try these solutions if you have Morton's Foot.  It can truly change someone's life in many cases.  If you need assistance, please make an appointment and we will happily take care of you.
 

 


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