Pre-dislocation syndrome of the second digit, also known as “crossover toe”, is a condition in which the second toe drifts toward the big toe and eventually crosses over and lies on top of the big toe. It is a progressive disorder that can begin at any age, but is most often seen in adults.
Although the crossing over of the toe usually occurs over a period of time, it can appear more quickly if caused by injury. Symptoms include: pain in the ball of the foot, or feeling like there is a marble in the shoe or a sock is bunched up. There can be swelling at the base of the second toe, and some may have difficulty wearing certain shoes.
Crossover toe is a result of abnormal foot mechanics, where the ball of the foot beneath the second toe joint takes an excessive amount of weight-bearing. This pressure eventually leads to weakening of the supportive ligaments and a failure of the joint to stabilize the toe, resulting in the toe crossing over. Certain foot abnormalities can make a person prone to experiencing excessive pressure on the ball of the foot, including: a severe bunion deformity, a second toe longer than the big toe, and an arch that is structurally unstable.
This condition is sometimes misdiagnosed, especially in the early stages when there is pain but the toe has not yet crossed over. The pain experienced mimics a Morton’s neuroma, but the two disorders are treated very differently – making it crucial to obtain an accurate diagnosis. Rest, ice, and oral anti-inflammatories may help relieve pain and inflammation. Immobilization, taping, or splinting may be necessary to prevent further drifting of the toe. Custom orthotics help stabilize the arch, and adding a metatarsal pad helps distribute the weight away from the joint. Surgical correction is an option if the deformity becomes severe and conservative treatments are not working.
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