What is Crossover Toe (Plantar Plate Problems)?
Crossover toe is a condition in which the second toe drifts toward the big toe, eventually crosses over and lies on top of the big toe. Crossover toe is a common condition that can occur at any age, although it is most often seen in adults.
Some people confuse crossover toe with a hammertoe, probably because both conditions involve a toe that does not lie in the normal position. However, crossover toe is much more complex and entirely different from a hammertoe.
Symptoms of Crossover Toe
Very early stage crossover
toe. This patient had pain in
the ball of the foot but very
little toe deformity.
Although the crossing over of the toe usually occurs over a period of time, it can appear more quickly if caused by injury, overuse or after a steroid injection to the area. Symptoms may include:
- Pain, particularly on the ball of the foot. It can feel like there's a marble in the shoe or a sock is bunched up.
- Swelling in the area of pain, including the base of the toe and usually on the bottom of the foot.
- Difficulty wearing shoes because of pressure of the shoes on the toe.
- Pain walking without shoe with pressure on the ball of the foot.
- Sores or ulcerations to the top of the crossed over toe.
Crossover toe is a progressive disorder. In the very early stages, a patient may have pain in the ball of the foot but the toe may not be crossing over. This is the best time to treat this problem. Without treatment, the condition usually worsens to dislocation of the joint, so it is very beneficial to have a Weil Foot and Ankle Surgeon evaluate the foot soon when pain first occurs.
What Causes Crossover Toe?
It is generally believed that crossover toe is a result of abnormal foot structure combined with abnormal foot mechanics. The combination of these two things can lead to repetitive stress on the area of the second toe joints which can lead to weakening of the tendons and ligaments that stabilize the toe. The result is a toe that changes position over time leading to a crossed over toe.
Certain conditions or characteristics can make a person prone to experiencing these problems: a severe bunion deformity, an arthritic condition of the big toe joint known as hallux rigidus deformity, an elongated second metatarsal, a second toe longer than the big toe, an arch that is structurally unstable and a tight calf muscle.The Weil Foot & Ankle Research Team has pioneered research aimed at identifying risk factors for this problem.
X-rays of a patient with a dislocated, crossover toe
MRI of a patient with a crossover toe
Ultrasound of the structures on the bottom fo the MTPJ. The picture
on the left depicts normal anatomy. The image on the right depicts
Crossover toe is often misdiagnosed, especially in the early stages when there is pain and subtle deformity but the toe has not yet crossed over. The pain experienced in crossover toe mimics a condition called Morton's neuroma. The two disorders are completely different and are treated differently. This makes it very important to make an accurate diagnosis.
In order to make an appropriate diagnosis, your Weil Foot & Ankle Surgeon will examine your entire foot, not just the area that is painful. He/she will press on certain areas and perform certain maneuvers in order to accurately reproduce your symptoms. The surgeon will also look for potential causes and test the stability of the joint.
Weight bearing x-rays are utilized to assess any underlying bone deformity that may be causing the crossover toe. X-rays will also allow your Weil Foot & Ankle Surgeon to assess other problems such as bunions and arthritis in the big toe joint which may be contributing to the problem.
Magnetic resonance imaging (MRI) may be ordered to assess the tendons and ligaments around the toe joints that may be damaged. MRI can also assess the cartilage inside the joint. While, MRI is the most accurate test to assess these ligaments and tendons, musculoskeletal ultrasound can also be used to assess the ligaments on the bottom of the foot that may be damaged in this condition. The Weil Foot & Ankle Institute has three extremity MRI’s on site at our Des Plaines, Highland Park, and Lincoln Park locations. These extremity MRI’s only take about 30 minutes for the study and only requires the patient put their foot into a painless machine avoiding the uncomfortable claustrophobia that some MRI devices create.
Ultrasound is a quick and easy exam; however, it does not have the same accuracy as MRI and is very dependent on the technician performing the exam.
How do you treat Crossover Toes?
Once an accurate and complete diagnosis is made, treatment options can be discussed.
Treatment: Non-Surgical Approaches
The best time to treat crossover toe is in the early stages, before the toe starts to drift toward the big toe. At that time, non-surgical approaches can be used to stabilize the joint with bracing, strapping and taping techniques. Orthotics with a special modification can be used to alleviate excessive pressure in the area underneath the toes. Softer, wider shoes with a deeper toebox can also be used to treat this condition.
Although surgical treatment for this condition has shown success, non-surgical treatment can be considered for patients who are unwilling to undergo surgical correction, patients with decreased blood flow to the legs (which can result in wound healing problems), patients who do not walk or patients where the risk of anesthesia is greater than the benefit of the surgery.
Treatment: Surgical Treatment for Crossover Toes
Once the second toe starts moving toward the big toe, it will not return to its normal position. Surgical correction of this problem can be performed to re-align the toe, repair any damaged ligaments or tendons and correct any underlying bone deformities that are present. As this condition has several underlying factors, each patient must be individually assessed and the proper combination of procedures selected by your Weil Foot & Ankle Surgeon.
The surgical procedure used at the Weil Foot & Ankle Institute to correct a crossover toe is the dorsal approach plantar plate repair. The surgeons at our institute have created and pioneer this procedure. To date, almost 200 procedures have been performed with follow up ranging to as long as 5 years.
After surgery, you will be in a bandage and a wooden bottomed shoe for 7 – 10 days. During your first visit after surgery, you will be allowed to get back into gym shoes and you will begin physical therapy to strengthen the muscles and tendons around the crossed over toe. You should be able to return to activities and other shoe gear at approximately 8 weeks after surgery. We expect that our patients have a full recovery from this procedure.