Patient Education

Crossover Toe

Description

Sometimes the second toe of the foot (the one right next to the big toe) gets a little adventurous. Sometimes it wants to strike out on its own. So, it wanders on over and tries to climb over the big toe and ends up causing a whole host of problems in the process. This condition, commonly referred to as ‘crossover toe,’ is likely caused by a structural abnormality in the foot, which puts more stress than usual on the bottom of the second toe. (That’s where the second toe connects to the second metatarsal (one of five long thin bones that stretch across the middle of the foot), just above the ball of the foot.) People with hammertoes, bunions, or second toes that are longer than the big toe may be more likely to have these adventurous second toes. Sometimes it’s also due to an unstable arch, or tight calf muscles.

Whatever the cause, the extra stress makes the joint deteriorate; the ligaments holding the joint in place lose strength and are no longer able to keep the toe in place. They’re not strong enough to rein in the second toe’s wandering heart. Eventually, the toe starts to shift over and crosses over the big toe (hence the ‘crossover toe’ moniker).

Symptoms

Crossover toe is not necessarily going to be obvious when things start going wrong. You’re likely to start out by feeling pain in the ball of your foot near the base of your second toe. (This may be caused by tearing of the capsule that underlies the joint.) It may feel like you’re walking around on top of a round rock or marble. (Of course, you may actually have a marble in your shoe. So check for stray playthings in your shoes before you march to the podiatrist’s office.) The base of the toe might also become inflamed (your body’s response to injury), which means that the area might become swollen, painful, red and warm. You may also find that shoes are getting more and more uncomfortable.

As the condition progresses, the second toe begins to obviously drift over to one side, and may eventually rest almost entirely on top of the big toe. It’s very important to go in to see your podiatrist when you first start to experience symptoms. Once your toe actually gets to the point where it’s crawling over its larger neighbor, surgery may be the only way to get things aligned properly again. So, if you fail to find a marble when you upend your shoe, you’ll probably want to make an appointment with your foot doctor.

Diagnosis

Your podiatrist will likely take a look at your foot, and may manipulate it (by pressing on or moving it) to see if he or she can pinpoint where the pain is and see how stable the joint is. He or she may suggest X-rays or other imaging methods (like CT scans or MRIs) to ascertain what the joint looks like inside.

Treatment

If you’re able to catch the crossover toe before it actually starts to wander off, it will be much more likely to respond to more conservative treatment methods. These may include treating the inflammation around the joint to reduce the pain. This is primarily accomplished by staying off the foot as much as possible, using ice (20 minutes on and 40 minutes off, with a thin towel between the ice and your skin), and taking anti-inflammatory medications such as ibuprofen or cortisone injections. Your podiatrist may also immobilize the area with a cast or brace to give the joint time to heal.

There are also methods your podiatrist may use to try to correct the problem that’s causing the joint pain. He or she may tape or splint the toe in place so that it keeps its proper position, or may suggest orthotics (prescription shoe inserts designed specifically for you) or a stiff-soled shoe to provide extra support to the joint. (Stiff soles help prevent stress on the ball of the foot.) Stretching out your calves may also provide some relief and added stability if tight calf muscles has been a contributing factor.

If these methods fail to reduce pain, or if the second toe has already begun its epic journey over your big toe, then surgery will likely be necessary to bring it back to the place it belongs. If the joint capsule is damaged, your foot surgeon will likely repair it. It’s best to discuss surgical options with your podiatrist, who can recommend the best procedure, taking into account your lifestyle and the progression of your condition.

You may feel that you’re doing your second toe a disservice by keeping it from going where it apparently wants to: over your big toe and off into the wilds of your foot. However, all things considered, it will probably be happiest (and will certainly make you happier) if it’s back where it should be: nestled nicely between your big toe and your third toe.