One condition podiatrists and foot and ankle surgeons see very often is cross-over toe. Most of the time, the second toe is the culprit, crossing over the great toe, but sometimes the big toes will cross over or under the second toe. Either way, this is a sign of foot misalignment and probably a bunion.
What to do about bunions
If the base of the great toe becomes enlarged, a bunion results. This is often caused by misaligned bones in the big toe. This problems causes the tendons and ligaments surrounding the joint to stretch. It also causes inflammation of the soft tissues covering the joint. Sometimes extra bone forms around the joint, and this can be very painful. Left untreated, the joint cartilage will break down and osteoarthritis will ensue.
How do you know you have a bunion?
If your bunion is quite advanced, it is also quite obvious. You may notice that a bony lump has developed on the side of the joint. The big toe may becomes seriously misaligned and may cross under or over the second toe. A swollen, inflamed bunion causes significant and painful foot deformity.
What causes bunions?
If the big toe joint is unstable, a bunion is likely to form. You may have unstable toe joints due to heredity, and you may increase your risk of developing a bunion through poor foot care habits. Wearing narrow shoes or high heels is a prime cause of foot malformation and bunion development. It only stands to reason that if you wear pointy-toed shoes that crowd your toes together, you are just training your toes to cross over one another while causing real and lasting damage to your toe joints.
Bunions may also be caused by acute injury; conditions such as arthritis or some nerve disorders; flat-footedness and simple, age-related wear and tear. To sum it up, bunion-related cross-over toe may be caused by a wide range of damages and conditions affecting the nerves, ligaments and joints of the toes.
What about hammer toes?
Sometimes the second toe crosses over the big toe due to a condition known as hammer toe. This is a painful condition that affects the entire toe and the area where it attaches to the ball of the foot. The toe may become hot, red and swollen. Its malformation may cause undue pressure with footwear, resulting in blisters, corns and calluses.
What causes hammer toe?
As with bunions (and many other painful foot conditions) improper footwear is often to blame for hammer toe. This condition develops over years of wearing shoes that crowd the toes and put undue weight and stress on the forefoot.
High heels do terrible damage to feet by putting tremendous pressure on the ball of the foot. This causes injury to the structures that stabilize the toes. In particular, the plantar plate is very susceptible to injury. When this happens, many other foot structures become unstable and lead to toe cross-over and toe deformity.
What to do?
First and foremost, invest in good, supportive footwear. Look for wide shoes with a roomy toe box to relieve pressure on the joints and the toes.
See your podiatrist to discuss the use of orthotic devices. He or she may prepare some custom supports for you; however, it is more likely that you’ll just get recommendations for affordable over-the-counter (OTC) shoe inserts, toe splints and spacers, arch supports and the like.
Your doctor may also recommend prescription or OTC pain relievers. If your pain is severe, an injection of corticosteroids may be helpful. Cortisone injections should be an almost-last resort as they only treat symptoms in the short term and may cause more damage in the long term. If you are not able to gain relief from these measures, surgery may be in order.
When should you see your podiatrist?
It’s always a good idea to consult your doctor about foot pain. Some symptoms that should concern you include:
- Trouble walking or participating in activities of daily living
- Redness, swelling and/or heat in the joints
- Toe deformity that keeps getting worse
- Difficulty finding shoes that fit
- Pain on the knuckle of the toe
- Thick calluses on your toes
- Ball of foot pain
You may wish to modify your activities to reduce the pain and inflammation of a hammer toe and/or bunion, but if you find you are unable to walk or participate in normal activities, you need to seek help from your doctor.
The goal is to heal the deformity so your podiatrist may recommend some physical therapy to help build up the muscles in your feet. Good stretching techniques can help with tight muscles, tendons and ligaments. Inflammation may be reduced with ultrasound treatments.
Surgery for cross-over toe
There are a number of procedures that deal with big toe crossing over second toe. Specifics vary depending upon which toe needs attention, the severity of the condition and your overall health. Sometimes correcting a cross-over toe requires bunion surgery. In the case of hammer toe, the surgery may be a matter of removing the affected bone within the crossed toe, realigning the toe and relocating it at the point where it connects to the ball of the foot.
Bunion surgery to correct cross-over toe may involve joint replacement. This is especially true if the problem is caused or exacerbated by osteoarthritis.
Cross-over toe surgery is usually a day-patient procedure. It may be performed using regional, local or general anesthetic. In case of acute injury or very involved damage, an overnight hospital stay may be advised. Discuss your situation with your doctor to be sure you understand all the particulars of your treatment before you go “under the knife”.