One of our patients, Joan, in every way looks and acts younger than her age (68). She stays trim by working out at the gym (CrossFit) and playing tennis. She also has one little secret that’s making her feel decades older than her chronogoical age. Can you guess? Probably not, unless you’ve seen Joan in open-toed shoes or sandals— which you will not. Joan has been hiding her deformity for too long. Now it’s time for treatment, and perhaps a restoration of her own sense of vitality. Not a moment too soon. You may have seen this syndrome in your own grandmother or another older woman. It’s called crossover toe.
With this condition, the second toe drifts over to eventually ‘hitchhike’ a ride on the big toe. At first, it may be a mere annoyance— ‘funny’ or ‘creepy’ are words that crop up. But after a while, it becomes uncomfortable to walk or wear shoes.
At that point, it’s time for a consultation. At our clinics in DeSoto, Dallas or Sunnyvale, we see plenty of these cases, and almost every patient is astonished that this weird thing could be happening to him or her.
Probable causes of crossover toe
Medical researchers believe that crossover toe is caused by a structural deformity in the way the foot is shaped, or in how it moves. The problem can be found in persons of any age, although it’s more common in older people and in women. As Joan explained, it feels like she is walking with a marble under her toes. There is a fair amount of pain in the early stage. Later, as the toe drifts farther and farther towards the big toe, there may be less pain but the foot is constricted in the shoe. People on the street began to comment whenever Joan appeared in sandals (‘What is wrong with your toes?’). Eventually, she said, the crossover toe syndrome began to interfere with her tennis game. That’s when she came to see us. After we examined Joan, the diagnosis was pretty straightforward. We also ordered x-rays to show the position of the bones.
With crossover toe, we have various conservative measures to help restrain the drift and minimize discomfort. Some therapies include:
- Taping the toe to prevent more movement. Taping will not correct the situation but it will help reduce inflammation in the foot and provide stability.
- Foot pads placed in the shoe may reduce discomfort by redistributing the weight on the plantar surface (sole) of the foot.
- If there is inflammation in the foot, an anti-inflammatory medication may relieve swelling and improve patient comfort.
- Custom orthotics for the shoe may relieve stress on the metatarsals (long bones of the foot) and allow more space for a thickened fat pad.
Crossover toe responds best to early intervention. Once the condition has advanced, the only option may be surgery.
Goal of surgery is to relieve discomfort
The type of surgery depends on the severity of the crossover syndrome. Some cases can be corrected by a soft-tissue procedure; other cases require osteotomy, or bone surgery, to shorten or align the bone. Doctor decides on the type of surgical procedure after carefully examining the individual patient and noting his or her symptoms. Post-surgical care is important. We usually advise the patient to wear stiffer shoes to prevent pressure on the affected structures in the foot.
In Joan’s case, we were able to treat the condition without surgery. Orthotics, careful choice of footwear, taping, calf stretches and other remedies allowed her to resume playing tennis and start feeling her ageless self again.
Early intervention is key. If you notice that one of your toes is hitching a ride— or starting to nudge up against big brother— give us a call. Any one of our clinics (DeSoto, Sunnyvale, Dallas) can help get you started on the road to relief.