Crossover toe is a common foot problem that can cause significant pain, and make walking difficult, while inhibiting physical activity. Individuals with hammertoes, bunions, or a second toe that extends beyond the big toe, are most susceptible to developing crossover toe as they age. A problem in which the second toe gradually moves across the big toe, it is similar in appearance to a hammer toe, but other than appearance, this is a completely different issue. It is a much more complicated than a hammertoe.
The first symptom of crossover toe is pain in the ball of the foot caused by a tear in the underlying joint capsule (plantar plate). This fosters instability that allows the second toe to fall out of alignment and eventually drift. Pre-existing forefoot problems, combined with normal wear and tear or possible trauma, can cause the plate to tear over time. A tight calf muscle could be a contributory factor too. Decreased flexion at the ankle joint, means more pressure on the ball of the foot. These pains are the first warning signs indicating the second toe might crossover and eventually limit activity.
Pain in the ball of the foot at the base of the second toe.
Swelling in the ball of the foot under the second toe.
Restricted or painful motion of the toe.
Instability of the second toe joint.
For someone without adequate sensation, this can become a significant risk for an ulceration and subsequent bone infection.
Until you are able to be examined by a doctor or podiatrist, the RICE method should be followed. This involves:
Rest It is crucial to stay off the injured foot, since walking can cause further damage. Non-weight bearing with crutches or a walker is ideal. A surgical shoe can help to immobilise this joint to a lesser extent, but will still be much better than normal shoes. It will reduce motion at this joint.
Ice Apply an ice pack/bag of ice over a thin towel to the affected area, for 20 minutes periodically throughout the day, to reduce swelling and pain. Do not put ice directly against the skin.
Compression Wrap the ankle in an elastic bandage, or wear a compression stocking to prevent further swelling.
Elevation Keep the foot elevated to reduce the swelling. It should be even with, or slightly above the hip level.
Other Treatment Options
Taping down of the second toe. This may change the imbalance around the toes and thus relieve the stress and pain.
Using wider fitting shoes
Using orthotics with a metatarsal pad to stabilise the joint
Exercises to stretch the calf muscle and increase motion at the ankle joint.
Surgery to correct crossover toe is an outpatient procedure. Patients with bunions or hammertoes are advised to have those deformities corrected during the surgery. Recovery time is about eight weeks.
Surgery may involve the following:
Shortening of the second metatarsal to allow the toe to move back into proper position.
Tendon transfer moving the tendon from the bottom to the top of the toe to stabilise the joint.
Pin fixation to hold the toe in the correct position (4-6 weeks) .
Walking cast for 6 weeks.
What to expect with Surgical Correction
This is aimed at ultimately relieving pain at this joint, and straightening the toe. A fusion is likely to be needed to maintain this straight position. A fusion is a common procedure to correct significant toe deformities. It will help the toe to not bend in the middle anymore, but will remain straight as intended. There will probably be a wire extending through the end of the toe to maintain this position for 4-6 weeks.
Additionally, the toe and joint will remain stiff for between 6-12 months after surgery, and may not bend up and down at the joint as well as it did prior to surgery. The toe may drift slightly back towards the big toe over time. To help maintain position after surgery for up to several months, a toe splint is highly recommended. It is important to remember that this deformity is being corrected because of pain and because the toe is crossing over the big toe. With this type of deformity, surgical results vary greatly from patient to patient.
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