Crossover toe is a painful condition in which the second toe drifts out of place, eventually crossing over and lying on top of the big toe. In some cases, the second toe lies under the big toe. Crossover toe can occur at any age, but is most commonly found in middle age and older adults.
Don’t confuse crossover toe with hammertoe. While both conditions involve a toe (any toe can be affected) that doesn’t lie in its normal position, they are quite different, and crossover toe is a much more complex condition. When a toe is described as being a crossover toe, it has become buckled, contracted, or crooked, and has literally crossed over or under the big toe (or adjacent toe).
Crossover toe is a progressive condition, usually occurring over a period of time. But it may also appear after an injury, from overuse, or after a steroid injection to an area near the second toe.
What causes crossover toe?
It’s generally believed that crossover toe is caused by abnormal foot structure and faulty biomechanics, as are bunions. The combination of these conditions leads to repetitive stress on the joint of the second toe, weakening the structures which stabilize it. The result is a toe that drifts out of place and becomes a crossover toe.
Other foot conditions accompany and may contribute to crossover toe, such as bunions, hammertoe, neuroma, arthritis in the big toe joint (hallux rigidus deformity), an elongated second metatarsal (2nd toe is longer than the big toe), a tight calf muscle, or an unstable arch.
What causes Crossover Toe?
In a normal foot, the plantar plate and associated ligaments stabilize the 2nd metatarsal joint. When chronic inflammation or damage occurs in this area, the stabilizing structures of the joint slowly change. One by one, the supporting ligaments fail, leading to chronic hyperextension on the toe joint, which then stretches or re-attenuates the plantar plate. This change in the toe’s supporting structures causes an imbalance, leading to instability in the toe, which eventually dislocates in the direction of the big toe.
Crossover toe can be difficult to diagnose in its early stages, when it’s most easily treated. A patient may have pain in the ball of the foot, but the toe exhibits no signs of dislocation. Unfortunately, without treatment, the toe will worsen and eventually dislocate. But if the crossover toe is detected by a podiatrist at an early stage, non-invasive treatments like bracing, strapping, taping, and orthotics can be employed to keep the toe from becoming a crossover toe. Once the second toe begins to drift towards the big toe, it will not return to its original position.
Symptoms of Crossover Toe
- Pain and swelling at the base of the second toe, and/or the ball of the foot. The discomfort on the bottom of the foot is often described as feeling like there’s a marble in your shoe
- Difficulty wearing shoes, as the toe becomes irritated by footwear
- Pain when walking, especially in the ball of the foot
- Soreness to the top of the crossover toe
Treatment for Crossover Toe
Taping positions the affected toe in it’s original alignment, which provides stability and relieves pain and swelling. As the inflammation of the joint decreases, healing can occur over a period of months.
Metatarsal pads and orthotics can alleviate pressure on the plantar plate and/or metatarsal and redistribute body weight across the surface of the foot. Healing can slowly occur as inflammation subsides.
Over the counter anti inflammatory medicine like aleve and advil can decrease inflammation and pain in the symptomatic joint.
If these conservative treatments fail, or if the displacement of the toe is far advanced, surgery to re-align the toe followed by physical therapy may be recommended by your podiatrist.