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. Crossover toe is a common condition that can occur at any age, although it 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 or overuse. Symptoms may include:
- Pain, particularly on the ball of the foot. It can feel like there’s a marble in the shoe or a sock is bunched up.
- Swelling in the area of pain, including the base of the toe.
- Difficulty wearing shoes.
Crossover toe is a progressive disorder. In the very early stages—the best time to treat crossover toe—a patient may have pain but no crossover of the toe. Without treatment, the condition usually worsens to dislocation of the joint.
It is thought that crossover toe is a due to abnormal foot mechanics, where the ball of the foot beneath the second toe joint takes an excessive amount of weight- bearing pressure. 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 conditions or characteristics can make a person prone to experiencing excessive pressure on the ball of the foot. These include:
- severe bunion deformity
- second toe longer than the big toe
- arch that is structurally unstable
- Rheumatoid arthritis
The best time to treat crossover toe is in the early stages, before the toe starts to drift significantly toward the big toe. At that time, non-surgical approaches can be used to stabilize the joint, reduce the symptoms and address the underlying cause of the condition. Non-operative treatment options include:
- Rest and ice - Staying off the foot and applying ice packs help reduce the swelling and pain. Apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
- Oral medications - Nonsteroidal anti-inflammatory drugs, such as ibuprofen, may help relieve the pain and inflammation.
- Immobilization - Sometimes the foot is immobilized for a while so that the injured tissue can heal.
- Taping/splinting - It may be necessary to tape the toe so that it will stay in the correct position. This helps relieve the pain and prevent further drifting of the toe.
- Stretching - Keeping the calf muscles stretched is important in patients who have tight calf muscles.
- Shoe modifications/orthotics - Supportive shoes with stiff soles are recommended because they control the motion and lessen the amount of pressure on the ball of the foot.
Surgery is necessary when the second toe drifts over and/or above the great toe. Typically the toe will not go back to its normal position when this point is reached. A variety of surgeries can be performed and the specific type or combination depends on the amount of deformity and other patient related factors.