Crossover Digits on Your Foot

Predislocation Syndrome (Synovitis)

The Problem

Drifting of the second toe towards the big toe causing pain, deformity and early development of an overlapping second toe over the big toe. The second toe begins to curl as well.

Causes

• Trauma to the second toe joint causing inflammation to that region.
• Inflammation of the nerves on the ball of the foot (neuroma), weakening the joint.
• Long second toe or metatarsal, causing a hammertoe and excess stress on the ball of the foot.
• Weakness or tearing of the outer joint ligaments holding the second toe straight.
• Stretching or tearing on the ligament on the ball of the foot called the "plantar plate".
• Pressure on the second toe from a bunion deformity causing the toe to drift.
• Pressure on the second toe due to a crooked big toe (hallux deformity).

Signs & Symptoms

• Visible space between second and third toe while bearing weight. The third toe may also drift inward.
• Pain to the second toe joint (both top and bottom) that increases with walking.
• Difficulty walking barefoot and inability to wear heels.
• Drifting of the second toe towards or over the first toe (overlapping toe).
• Hammertoe of the second toe.
• Neuritis (inflamed nerve causing numbness, burning and/or tingling).
• Associated with bunion deformity and/or crooked big toe.
• Swelling of the second toe and/or ball of the foot.
• Callus (hard skin) on the ball of the foot because of metatarsal overload.

Treatment Options

• Anti-inflammatories to decrease inflammation in the area.
• Stiff-sole shoes to prevent toe bending.
• Avoiding heels
• When there is difficulty walking, temporary immobilization in a boot can eliminate pain.
• Taping of the toes to lessen pain and deformity.
• A small, carefully-directed cortisone injection can help in the case of severe pain. A boot will be necessary with it.
• Surgery to realign the joint and help achieve a fully recovery. Surgery may include:
• Ligament repair
• Shortening the metatarsal (weil osteotomy)
• Fusion of the second toe
• Removal of inflamed tissue (synovectomy)

A pin may be necessary in the toe for up to six weeks. It would also be necessary to walk in a boot. A correction of a bunion at the same time may be necessary as it can be the underlying cause of the deformity.

Prognosis

Excellent with regard to eliminating the pain and lessening the deformity. The earlier the treatment, the better the long-term prognosis.

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