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1976

Dr. Burton Schuler
Podiatrist - Foot Specialist - Foot Doctor
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Panama City, FL 32401

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    Panama City Podiatrist, Metatarsal & Heel Pain are related

     ( This article was originally published internationally in March 2011)

    Dr. Burton S. Schuler, Podiatrist, Panama City Fl, new book Why You Really Hurt: It All Starts In The Foot

    Why You Really Hurt: It All Starts In The Foot, by Dr. Burton S. Schuler


    Heel pain is a general term that includes many different etiologies including: plantar fasciitis, plantar fasia tear, tarsal tunnel syndrome, Baxter’s nerve entrapment, calcaneal stress fracture, calcaneal cysts, soft tissue mass, short flexor tendon tear, gout, and systemic arthritis (lupus, rheumatoid arthritis, psoriatic arthritis).  While plantar fasciitis is the most common of these conditions, it is highly possible that heel pain could be something else and thus foot and ankle specialists need to be familiar with the range of possible diagnoses (http://www.mayoclinic.com/health/plantar-fasciitis/DS00508).  One problem is that patients do not present right away when experiencing heel pain, unless they have an actual fascial tear that occurs during intense exercise, and is characterized by a “pop” sensation.  Patients who have pain but do not experience an intense tear are likely to try many home therapies and endure weeks to months of chronic low-grade pain.

    Dr. Burton S. Schuler   has treated thousands of heel pain cases in his over 35 years podiatry of practice An author of two books on feet, including his most recent, Why You Really Hurt: It All Starts in the Foot, Schuler links heel pain to a short or hypermobile first metatarsal bone, which is a common condition but not so commonly linked to heel pain.  Schuler makes a strong case for this connection between toe length and heel pain.  This connection was made earlier by  predecessor, Dr. Dudley Morton, who taught at Yale and Columbia  medicals schools in the 1920-1940’s;  and  who wrote extensively about the short first metatarsal bone. This medical condition came to be known as “Morton’s Toe” because of Dr. Morton’s consistent research and writing on the condition (http://whyyoureallyhurt.com/#djm). 

    The first metatarsal bone is supposed to carry twice the weight as the second.  But when it is shorter, it cannot carry this weight, requiring weight to be unevenly distributed and causing the second metatarsal bone to meet the ground before the first.  The second metatarsal bone begins to do the first bone’s share of work, which places abnormal stress on many area of the foot—and that pain can spread not only to the legs but throughout the body.  Another physician influenced by Dr. Dudley Morton, Dr. Janet Travell, studied how Morton’s Toe can be linked to myofascial pain in the body.  Dr. Travell was a White House doctor to both Presidents Kennedy and Johnson, and she had attended Morton’s lectures on the foot (http://www.footcare4u.com/category/dr-janet-travell/).  Dr. Morton, Dr. Travell, and their contemporary equivalent, Dr. Schuler, remind us that causes of chronic heel pain can be demystified if we consider the cases of people with short metatarsal bones. 

     

    About the Author:  Dr. Burton S. Schuler foot doctor, foot specialist, podiatrist  of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center  and is a leading authority on the Morton’s Toe,  Long Second Toe and it associated problems.

     

    Podiatrist writes about new clinical guidelines for Heel Pains

    Dr. Burton S. Schuler, Podiatrist, Foot Doctor, Panama City Fl

    Dr. Burton S. Schuler, Podiatrist, Foot Doctor, Panama City Fl

     Dr. Burton S. Schuler,  Podiatrist,   of Panama City Fl  writes about the newly published clinical guidelines developed by the American College of Foot and Ankle Surgeons (ACFAS) will help medical practitioners diagnose and treat common foot problems, with the most common being heel pain.  Available to download at (http://www.acfas.org), a committee of prominent heel pain specialists helped develop the guidelines.  Out of all adult foot complaints, plantar fasciitis constitutes 15% of these complaints.  The plantar fascia is a broad ligament connecting the heel to the toes.

    (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004438/).  This condition, heel pain caused by chronic inflammation of this tissue, is very painful, can lead to spurs (abnormal bone growth that occurs at the bottom of back of the heel) and occurs frequently in adults 40years and older.  Overweight people are likely to suffer from plantar fasciitis because their feet suffer from the extra weight.  Women are especially prone to suffer from plantar fasciitis, and this is perhaps most likely caused by inappropriate footwear, such as high heels.  

     Podiatrist Dr. Burton S. Schuler, of Panama City, Fl and author of Why You Really Hurt: It All Starts in the Foot, and The Agony of De-Feet: A Podiatrist’s Guide to Footcare, has practiced podiatry in Panama City, Florida for over 27 years since he graduated from New York College of Podiatric Medicine in 1975 at the age of twenty four. (http://whyyoureallyhurt.com/).  During this time, he has treated many patients suffering from plantar fasciitis.  He reports that over 90% of his patients with heel pain have a short first metatarsal bone or hypermobility of the first metatarsal bone, also known as Morton’s Toe.  Schuler explains the simple connection between heel pain and a short first metatarsal bone.  Morton’s Toe destabilizes the front part of the foot, causing the foot to pronate, placing stress on many parts of the foot—including the plantar fascia. 

    What can you do about a Morton’s Toe?  Schuler prescribes a simple $2 toe pad that can be placed beneath the bottom of the first toe in order to help stabilize the front part of the foot: it acts as a platform and removes the slack of the ligaments around the first metatarsal bone (http://whyyoureallyhurt.com/home/#tp).  A stable foot properly distributes weight, alleviating the unnecessary stress placed on areas like the plantar fascia, and this in turn reduces or can even eliminate heel pain.  Keeping in mind that the success of the treatment depends on many factors, if you suffer from chronic heel pain this is one possible cause that should be considered and treated accordingly.

     

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    Sever’s Disease (Heels) Explained by Panama City Podiatrist

    Unlike adults, heel pain is very uncommon in children.  When children do experience heel pain, it is highly likely to be caused by a disturbance to the growth plate in the backof the heel bone (calcaneus), where the Achilles tendon attaches to the heel. This disturbance is known as Sever’s disease or calcaneal apophysitis (inflammation of the growth plate). Sever’s disease is most common between the ages of 10 and 14 years, and it is one of several different ‘osteochondroses’ that may occur in other parts of the body, such as at the knee, such as Osgood-Schlatters Disease 

    This condition occurs in children because they are still growing and their bodies harbor many “growth plates”.  A growth plate, also called an epiphyseal plate, is an area at the end of a developing bone where cartilage cells change over time into bone cells. As this occurs, the growth plates expand and unite, which is how bones grow.

    Physically active children run the risk of developing Sever’s disease because they put the most strain on their growing bones. Sever’s usually occurs during the adolescent growth spurt, when young people grow most rapidly. (This growth spurt can begin any time between the ages of 8 and 13 for girls and 10 and 15 for boys.) By age 15 the back of the heel usually finished growing.  As teens grow, the growth plates harden and the growing bones fuse together into mature bone.

    Young people engaged in physical activities and sports that involve jumping and running on hard surfaces–such as track, basketball, soccer, and gymnastics—are ata higher risk for developing Sever’s disease.  Poor-fitting shoes can contribute  by not providing enough support or padding for the feet or by rubbing against the back of the heel (http://kidshealth.org/parent/medical/bones/severs_disease.html). 

    Also, if you have a pronated foot (one that rolls in at the ankle when walking), a flat or high arch, which causes tightness and shortening of the Achilles tendon, one leg shorter than the other (short leg syndrome), or you are overweight, you are also at a higher risk for Sever’s disease.

    Even if pain associated with Sever’s disease promises to elide over time through the normal maturation process of fusing bones, an article in Podiatry Today states there are still measures that can be taken to treat Sever’s disease, thus alleviating the pain associated with it

    1.)   During an initial 2-3 week  period  I use physical therapy in combination with padding of strapping of the feet.

    2.)  During the rest and recovery period, one can prescribe analgesics such as non-steroidal anti-inflammatory medications (NSAIDs) along with daily icing to the affected heel.

    3.)  After the rest and recovery period, the “squeeze test” of the heel should be performed. If pain has elided, treatment should focus on increasing the strength and the biomechanical factors that contributed to Sever’s. At this time, patient can perform low-impact exercises such as the use of a stationary bike (at low resistance) and swimming.  They may use a treadmill if their heel is fitted with an appropriate orthoic life that protects strain in places that exacerbate the Sever’s disease.

    4.)  During the next period— Orthotics with deep heel cups and a rearfoot posting for added motion control can be used.  

    About the Author:  Dr. Burton S. Schuler foot doctor, foot specialist, podiatrist  of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center  and is a leading authority on the Morton’s Toe,  Long Second Toe and it associated problems. He is the author of the newly published book about The Morton’s Toe, Why You Really Hurt: It All Starts In the Foot. The book is published by the La Luz Press, Inc and is disturbed national by the Cardinal Publishing Group.  Why You Really Hurt: It All Starts In The Foot, is the story of how one bone in your foot could be the real reason for pains thru out your whole body. It is important because it offer the public new information about why millions of people suffer everyday with aches and pains, and offers new hope to get rid of problems they believed they would have to live with forever. It literally can be the “medical missing link”

      Dr. Schuler, graduated from the N. Y. College of Podiatric Medicine in 1975 at the age of twenty-four, and has been in private practice ever since. In 1982, he published his first book, The Agony of De-Feet: A Podiatrist Guide to Foot Care. During his thirty-five year professional career, he has written for Collier’s Encyclopedia and various podiatric journals and publications. He has been interviewed by The New York Times, First in Women, and other publications. Dr. Schuler has appeared on hundreds of radio and television programs both here and aboard. He is a Diplomate of the American Academy of Pain Management, and the National Board of Podiatric Examiners. Dr. Schuler is certified as a wound specialist from the American Boardof Wound Management. His professional and civic accomplishments have earned his inclusion in the 1999-2002 Who’s Who in America (Marquis). 

     

    Heel Pain Guidelines discussed by Panama City Podiatrist

    In the spring of  2010, new  guidelines for the  treatment and diagnosis of  plantar fasciitis and  heel pain  was  published by  the American College of Foot and Ankle Surgeons  .  The most common heel pain condition, plantar fasciitis, is an swelling of the plantar fascia, which is the rubber-band like structure  that goes from the ball of the foot to the heel.  Dr. Burton S. Schuler, foot specialist, podiatrist, foot doctor of Panama City Fl writes that these guidelines are controversial in the physical therapy community because the ACFAS suggests evidence to recommend physical therapy as a treatment protocol. Also, while corticosteroid injections are given an evidence grade of B in the guidelines, many including Dr. Burton S. Schuler,  http://www.footcare4u.com/category/about-dr-schuler/    objects to this heavy reliance on injections.

     Schuler says “I give injection in my office for heel pain and plantar fasciitist only when a more  conservative treatments like physical therapy, padding and strappings and medications,  has not work. Most patient appreciate this because most people are not thrilled about getting a needle stuck in their heel” 

    One thing that can be considered as a treatment for heel pain and plantar fasciitis is to consider whether you have a short first metatarsal bone, which can be treated using a toe pad under the first big toe of each effected foot .  This was named “Morton’s Toe” after Dr. Dudley J. Morton who was a renowned physician in the first half of the twentieth century.  Morton was the most famous U.S. expert on problems of the human foot.  Popular publications such as Reader’s Digest, Time Magazine, and the New York Times regularly quoted and cited him, and his medical books and articles were the leading authorities of their time

    Dr. Morton’s research on a second longer toe and heel pain is one topic addressed by Dr. Burton S. Schuler, who practices podiatry in Panama City, Florida, and is one of the country’s leading experts on the Morton’s Toe and how it affects the whole body.  He is the author of The Agony of De-Feet: A Podiatrist’s Guide to Foot Care, and Why You Really Hurt: It All Starts in the Foot  Schuler’s emphasis on treating heel pain is prevention and early diagnosis and treatment of Morton’s Toe to avoid heel problems overall.  While this is not the answer to all heel pain problems, early detection of Morton’s Toe leads to prevention of plantar fasciitis in enough cases to take notice of Morton’s research.

    Dr. Burton S. Schuler is a foot doctor, foot specialist (Podiatrist), of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center.    

     

     

     

     

    Florida Podiatrist discusses different Heel Pain Treatments

    Here is an article about heel pain, written about me

    According to an article in the Lower Extremity Review in June 2010, roughly 2 million Americans are affected each year by heel pain, and 10% of people experience chronic heel pain in their lives at some point (http://www.lowerextremityreview.com/cover_story/heel-pain-revisited-new-guidelines-emphasize-evidence).   Although heel pain is such a pervasive problem, there are diverging perspectives about how best to treat chronic heel pain.  Lower Extremity Review attributes some of these diverging perspectives to the “scope of practice…physical therapists can’t give cortisone injections or perform surgery and podiatrists are less familiar with physical therapy approaches” (http://www.lowerextremityreview.com/cover_story/heel-pain-revisited-new-guidelines-emphasize-evidence).

    One Panama City, Floridapodiatrist, Dr. Burton S. Schuler, who graduated from the New York School of Podiatric Medicine in 1975, is familiar with the many approaches taken to treating heel pain.  In his book, Why You Really Hurt: It All Starts in the Foot, Schuler advances his perspective that it is all too common to misdiagnose heel pain and rush to treat it with injections or surgery.  But, how about using a toe pad instead.   Schuler’s reasoning behind taping a toe pad underneath your first toe applies only if you have Morton’s Toe (or short first metatarsal bone).

    In his 36 years of podiatry practice, Schuler states that he has witnessed many patients’ heel pain diminish because they treated their Morton’s Toe.  Abnormal pronation of the foot can place undue stress on the arch and heel of the foot–eventually leading to chronic pain.  The toe pad alleviates this stress.  This treatment is a welcome alternative, as treatments like corticosteroid injections are discouraged by many as a first line of treatment, because “They don’t address a single issue that gave the person the problem,” says Michael Gross, PT, Ph.D. a professor of physical therapy at the University of North Carolina, Chapel Hill (http://www.lowerextremityreview.com/cover_story/heel-pain-revisited-new-guidelines-emphasize-evidence).  Many, including Gross, believe injections compromise tissue that is already weak.  And with such risks in treatment of heel pain, it is best to heed Dr. Schuler’s advice and check to see if you have Morton’s Toe; this could be the main cause of your heel problems, and it may be easier to treat in the long run.

    Poststatic Dyskinesia or why your Heels Hurt when you get up

    Patients in podiatry offices across America frequently complain of morning pain that is sharp and searing in the bottom of the heel–stretching to the arch of the foot.  This is not limited to the feet but can also cause pain in the back or neck when you first start to move around in the morning In fact, the medical term for heel pain, Poststatic Dyskinesia, www.footcare4u.com/category/foot-ailments-treatments/common-foot-ailments/bursitis/  means “pain after rest.”  It can also occur upon standing, after resting or sitting for a while, anytime during the day. Some patients state that they get this pain upon getting out of their car after driving for a while .

    /Poststatic Dyskinesia is most commonly caused by a Plantar Fasciitis. The plantar fascia is a thick ligament made from fibrous connective tissue attached from the heel to the ball of the foot, extending into the base of the toes.  When the foot impacts the ground with each step, the foot flattens out, lengthening the foot. This action pulls on the plantar fascia, which stretches slightly and functions as a shock absorber.  The ligament’s tension is released when the heel comes off the ground.

    When the plantar fascia stretches excessively, due to a variety of actions such as rigorous exercise, plantar fasciitis may develop. One cause of this is excessive pronation of the foot during walking and standing, which strains the plantar fascia. Panama City, Florida podiatrist Dr. Burton S. Schuler claims that excessive pronation can be caused by a short first metatarsal bone, also known as Morton’s Toe.  The foot does not absorb the shock of hitting the ground properly, resulting in strain on the plantar fascia.  This leads to plantar fasciitis and post-static dyskinesia

    When a person rests their feet, such as overnight while sleeping, the plantar fascia is mending itself from the wear and tear of the day. Then with the first few steps in the morning, the plantar fascia becomes torn again. This is why Poststatic Dyskinesia tend is worse the first few steps in the morning or after rest when the feet are relaxed and free of strain.  This burden can be avoided if you have Morton’s Toe and decide to follow the simple treatment regimen of a toe pad that can lead to a pain-free morning 

    WHAT IS A MORTON’S TOE OR LONG SECOND TOE 

    In the 1920’s and 1930”s Dr. Dudley J. Morton of Yale Medical School and Columbia Medical School wrote that a problem with the 1st metatarsal bone, known as a Morton’s Toe could be the reason for most foot problems. Dr. Janet Travel, White House physician to Presidents Kennedy and Johnson, and Professor Emeritus of Medicine at George Washington University took this concept further by writing and teaching that the Morton’s Toe could cause pain all over your body. She wrote and taught for four decades that a Morton’s Toe could cause back, hip, knee, leg foot and ankles problems. She felt that the Morton’s Toe, was so important that at the age of 89 she made a video tape to teach other physicians about how to recognize it and how to treat it. 

    WHAT IS WHY YOU REALLY HURT:  IT ALL STARTS IN THE FOOT

    Why You Really Hurt: It All Starts in the Foot, tells the story of two these famous physicians and their association with the common, but painful, medical condition known as the Morton’s Toe.  Millions of   people suffer everyday with chronic aches and pains from head to toe and don’t know why.  Many of them have lost all hope, and believe they will have to live with these pains for the rest of their lives. The book is significant because for the first time  in seventy years  the public is  made aware of the importance of the  Morton’s Toe, and the fact  that could be the real  unidentified reason  (the “medical missing link”)  for their  unending  torments. This book will also show how Morton’s Toe can also cause fibromyalgia, arthritis, sleep disturbances (RLS), temporomandibular joint pain, and numerous other problems through out the body The good news is that all of these problems can be treated with a simple pad that costs about two to three dollars. The bad news is  that in spite of the fact that two of the most famous doctors of the twentieth century were behind the Morton’s Toe, most modern day physicians are not aware of Morton’s Toe or of it ability of causing pain all over the body. This book took six years to research and write, but Dr. Schuler feels it was worth it because it should be able to help many people get out of pain. The book is disturbed national by the Cardinal Publishing Group. It will be translated to Greek this Year.

    Healing Your Heel Pain

    Back in February 2011 this article ran national 


                                                             This is a large heel spur  

    According to the American Academy of Orthopedic Surgeons website, every mile you walk puts 60 tons of stress on each foot (http://orthoinfo.aaos.org/topic.cfm?topic=a00159#Diagnosis).  If you pound your feet on hard surfaces playing sports or wearing ill-fitting shoes, you may develop heel pain.  The pain can worsen if people persist in performing activities that caused their original heel pain. When you continue to walk or exercise on a sore heel, it can become a chronic condition leading to more problems.   A sore heel will usually get better on its own without surgery if you give it enough rest.  But if you have other chronic foot conditions that cause or exacerbate heel pain, rest may not be enough treatment to eliminate the pain.

    For example, some of us are born with a short first metatarsal bone (Morton’s Toe).  Morton’s Toe is a chronic condition that will not go away (since this involves the length of your actual toe bones) so your heel pain can persist if you ignore your short first toes.  Dr. Burton S. Schuler, author of Why You Really Hurt: It All Starts in the Foot, states that there is a strong connection between tor length and heel pain.  He feels that this fact has been overlooked by most foot doctors and he invites them to verify the truth of this observation. If they did look for a Morton’s Toe, he feels “they would find one present the vast majority of time their patients appeared with heel or arch pain” ).

    Scientifically, it makes sense that a short first toe can have an adverse effect on the foot’s pronation, as Schuler argues, causing heel pain.  A certain amount of pronation is absolutely needed for the human foot to work properly because it allows the foot to become a “Bag of Bones” (loose), in order for it to act as a shock absorber as it adapts to all of the different walking surfaces we are on. This adaption (pronation) is only supposed take place for a split second. When it goes on longer than that split second is when we start to have a condition known as Abnormal Pronation (http://www.footcare4u.com/category/abnormal-pronation/).  And, as Schuler argues after treating foot problems for more than thirty years, it is abnormal pronation that can be the cause of chronic heel pain. But it can be treated with a simple toe pad

    More about healing your Heels, and other neat stuff

                                                                    A Large Heel Spur

    Many readers have probably heard of heel spurs, but they are not exactly sure what one is.  The foot’s largest bone is the heel bone, and therefore it absorbs the most shock and pressure. The plantar fascia is a band of fibrous tissue on the bottom of the foot, running the entire expanse of the foot.  A heel spur is an abnormal growth on the heel bone; when the plantar fascia pulls away from the heel, calcium deposits form, causing heel spurs.  This can be an extremely painful condition, impairing your ability to walk properly (https://heelthatpain.com/heel-spur/treatment/).

    In order to avoid a heel spur, one needs to avoid having the plantar fascia pull away from the heel.  The blog “Healthy  Happy Heels” is correct in stating that “…the stretching of the plantar fascia is usually the result of over-pronation…” (http://healthyhappyheels.blogspot.com/2010/12/what-is-heel-spur.html).  But then we must ask, what causes over-pronation?

    Dr. Dudley J. Morton, one of the leading researchers on feet in the twentieth century, warned about how a longer second toe (“Morton’s Toe”) can cause over-pronation of the foot.  His predecessor, Panama City, Florida podiatrist Dr. Burton S. Schuler, explains: “If you have a Morton’s Toe the front part of the foot is unstable when it needs to be stable. Because of this, the foot will be forced to pronate. A pronating foot places abnormal stress on many areas of the foot, including the plantar fascia and the heel bone. It is this abnormal stress that is the start of all the heel problems noted above.

    If a longer second toe is causing your painful heel problems, do not despair.  The toe-pad that Schuler prescribes for Morton’s Toe (placed under the first toe of an over-pronating foot) can help heal those painful heels—as it already has in many cases.

    About the Author:  Dr. Burton S. Schuler foot doctor, foot specialist, podiatrist  of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center  and is a leading authority on the Morton’s Toe,  Long Second Toe and it associated problems. He is the author of the newly published book about The Morton’s Toe, Why You Really Hurt: It All Starts In the Foot. The book is published by the La Luz Press, Inc and is disturbed national by the Cardinal Publishing Group.  Why You Really Hurt: It All Starts In The Foot, is the story of how one bone in your foot could be the real reason for pains thru out your whole body. It is important because it offer the public new information about why millions of people suffer everyday with aches and pains, and offers new hope to get rid of problems they believed they would have to live with forever. It literally can be the “medical missing link”

    Dr. Schuler, graduated from the N. Y. College of Podiatric Medicine in 1975 at the age of twenty-four, and has been in private practice ever since. In 1982, he published his first book, The Agony of De-Feet: A Podiatrist Guide to Foot Care. During his thirty-five year professional career, he has written for Collier’s Encyclopedia and various podiatric journals and publications. He has been interviewed by The New York Times, First in Women, and other publications. Dr. Schuler has appeared on hundreds of radio and television programs both here and aboard. He is a Diplomate of the American Academy of Pain Management, and the National Board of Podiatric Examiners. Dr. Schuler is certified as a wound specialist from the American Academy of Wound Management. His professional and civic accomplishments have earned his inclusion in the 1999-2002 Who’s Who in America (Marquis).

    Plantar Fasciitis, Heel Pain, Heel Spurs,

    There are many reasons for your heels and arches to hurt especially upon raising or by the end of the day, some of them are

    • Plantar Fasciitis

    • Heel Spurs

    • Heel Bursitis

    Plantar Fasciitis is a condition where the plantar fascia gets swollen and inflamed, again due to abnormal pronation.

    WHAT IS A HEEL SPUR? The heel bone is the largest bone in the foot and absorbs the most stress. A heel spur is an abnormal growth of bone either at the back of the heel, or most commonly on the bottom of the heel. The most common symptom of a heel spur is to have pain when first getting out of bed in the morning, or after resting for 20 minutes then getting up.
    WHY DO WE GET HEEL SPURS OR HEEL SPUR SYNDROME? The most common reasons for heel spurs and heel pain is due to excessive stress and stains applied to the heel bone and the soft tissues structures that attach to the heel bone when we walk. This abnormal stress and strain is caused by Abnormal Pronation, which is the result of having a Morton’s Toe