A crossover second toe deformity is a problem that occurs when the second toe subluxes dorsally and medially over the great toe. This causes problems with wearing regular shoes, because it rubs on shoes and causes pain.
When we see a crossover second toe occur, typically the plantar plate at the plantar aspect of the second metatarsophalangeal joint has torn. This ligament helps to stabilize the second toe, and if it tears, the second toe will dorsiflex. The typical compensation in an early stage tear of the plantar plate is a hammertoe deformity, where the second toe curls back down to try to touch the ground.
When the plantar plate fully ruptures, the second toe will dorsiflex even further and most of the time it will start to medially subluxed and go over the dorsal aspect of the big toe. This is a hard deformity to treat, because it can cause long-term pain and shoe irritation.
In early stage deformities, we typically recommend plantarflex taping of the second toe. A Budin splint is a type of pad that will hold the second toe down and pad the plantar surface of the second metatarsal phalangeal joint. A custom orthotic with a metatarsal pad built-in will also help offload this ligament and try to keep it from tearing further.
If the toe is completely crossed over, surgical intervention is another option. We typically need to either repair the plantar plate, or perform a flexor digitorum longus tendon transfer to try to stabilize the second toe. Often times, a second metatarsal shortening osteotomy and/or second hammertoe repair is necessary to get the toe to sit in a straight position.
If you are suffering from any foot and ankle pain or problems, the whole team at Foot and Ankle Institute of Colorado is here to help you. We provide care to all ages of patients from birth to the elderly, and we try to provide you the best treatment options that are currently available. Call us at 719-488-4664, so we can help you today!
