Crossover Toe

Crossover toe refers to a condition which involves the drifting of the second toe towards the big toe, until it crosses over and lies on top of it.

Crossover toe is most typically seen in adults.

It should be noted that crossover toe is a different condition from hammertoe, which involves the downward curling or bending of the toe. Crossover toe is considered a more complex condition than hammertoe.

What can cause crossover toe?

Crossover toe is the consequence of abnormal foot mechanics, which leads to the second toe joint taking a disproportionate level of weight-bearing pressure compared to the other joints of the feet. The supportive ligaments and plantar plate are weakened by this pressure, which leads to the joint being unable to stabilise the toe, and the toe eventually crossing over.

There are certain risk factors attached to crossover toe, including; a second toe which is larger than the big toe; a bunion deformity; a tight calf.

What are the symptoms of crossover toe?

The main symptoms of crossover toe, which can arise more quickly in the case of an injury, include; pain and a sensation similar to a bunched sock or a marble in your shoe; swelling at the base of the toe; and discomfort from certain types of shoes.

It is important to have symptoms which could signal crossover toe evaluated as early as possible. Failure to do so could see the condition progress to joint dislocation.

What are the symptoms of crossover toe?

In the stages before the second toe has crossed over, there is a bigger potential for crossover toe to be misdiagnosed. It can sometimes be confused with Morton’s neuroma. Diagnosis typically begins with a physical examination, including testing joint flexibility. X-rays and other imaging studies can also be ordered by your doctor.

There are many non-surgical treatments which can be recommended for crossover toe in its early stages. These include; rest, which focuses on reducing the amount of weight which is put on the affected foot; ice treatment, which applies a bag of ice to the joint for periods of 20 minutes at a time; immobilising the foot, allowing tissue that has been injured to heal; orthotic devices, such as pads and inserts which can offer extra support; shoe modifications, that can offer extra stability due to enhancements such as stiffened soles relieving pressure on the ball of the foot; stretching, to address tight calf muscles; and taping the toe to keep it in the correct position.

Oral medications which can help to relieve inflammation and pain include nonsteroidal anti-inflammatory drugs (NSAIDs).

Once the second toe has crossed over, surgery is required in order to return it to the normal position. Procedures can include the repairing of a bunion, the removal of a part of the bone, or the relocation of the toe where it meets the ball of the foot. The second metatarsal can be shortened to offload the joint using a Weil’s osteotomy. Minimally invasive techniques like DMMO and keyhole hammer toe or coronal plane correction can also be used.

As with all foot surgery it is common for swelling to persist for some months after surgery and is completely normal. This swelling will eventually completely subside with time and can take up to 12 months but often goes well before this.

Ankle pain can be distressing, especially if you're not sure what options are open to you. If you're wondering if surgery could help you, book an appointment.

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I saw Mr Ajis after sustaining a fracture of my 5th metatarsal which had not healed after a year. The pain was unbearable. He saw me promptly and took the time to explain my condition with the help of x-ray images with assurances that he could fix the problem. I was advised by other clinicians to be patient and wait for the fracture to heal on its own. Mr Ajis said that healing would be highly unlikely without intervention. After numerous emails and 'phone calls to him he constantly...

...spent the time reassuring me and patiently going over the intended procedure. To date after seeking advice and guidance from Mr Ajis, his secretary and the Physio Team and the insertion of a plate my fracture has united I walk well, without pain and I have joined a walking group.