Foot Care|Fla. Podiatrist Explains Instability of Toe Joint
Authored by Dr. Burton S. Schuler,
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Deformity of the lesser toes, most common of the second toe, often is caused by the instability of a major joint in the foot known as the metatarsophalangeal joints (mpj). This joint problem can range in form from mild to severity causing an irritation of the joint lining known as a synovitis of the metatarsophalangeal joint to dislocation of the joint. Chronic deformity of the mpj can also be the reason for hammer toe, or claw toes As always a Morton’s Toe or a long second toe , is the underlying cause of these toe problems and metatarsophalangeal joint problems. Dr. Dudley J. Morton, was right in 1927 and is right now. Bunions are also affected by the Morton’s Toe but also by metatarsophalangeal joint instability. Besides Morton’s Toe the other reasons of these changes likely are caused by chronic
Other causes of instability of the metatarsophalangeal joint include synovitis from arthritis, muscular imbalance, and acute traumatic to the ligaments of the metatarsophalangeal joint.
ANATOMY AND BIOMECHANICS
The most common site for synovitis, of the toes takes place at the second metatarsophalangeal joint. Normal toe position is dependent on muscle balance. The most important of them is extensor digitorum longus which extends the toe at the metatarsophalangeal joint. This supplies powerful extension force on the joint which stabilities the toe downward . The extensor digitorum longus tendon is able to extend the interphalangeal joints of the toe only when the metatarsophalangeal joint is in a stable position
There are two sets of muscles that work on the bottom of the toe . The second toe is unique in that there are two interossei. Normally these muscles work by pulling the 2nd toe down at the metatarsophalangeal joint. However, as the metatarsophalangeal joint becomes chronically overworked, by the interossei it can result in a dorsal dislocation of the joint.
The 2nd set of muscles is called the lumbrical muscle and are located on the inside side of the joint and pulls the toe outward also for the purpose of stabilizing the joint. While the lumbrical muscle normally passes on the bottom of the toe and acts as a stabilizer of the metatarsophalangeal joint Static restraints for joint stability include the collateral ligaments and the plantar plate. Chronic irritation of the joint, with a synovitis and joint swelling causes degeneration, rupture of these structures, and in the end the . metatarsophalangeal joint
One of the first thing a patients with synovitis and instability of the metatarsophalangeal joint see is a slowly progressive course of metatarsalgia, or pain and or burning on the balls of the feet. Occasionally, radiation pains into the second and third toes can occur. This is the start of a neuroma . Initially, pain occurs while walking, but as the problem progresses, some patients may have pain with rest. On examination, a hammer toe may or may not be present. As the deformity progresses, a plantar callus may also develop.
In the early stages of when there is a minimal deformity treatment can be intraarticular cortisone injection, oral anti-inflammatory, physical therapy, padding and strapping and finally orthotics Most patients can be treated that way..
Once there is a significant deformity or instability , conservative treatment may not be sufficient.
There are numerous surgeries for these problems that are available depending on the deformity. The best one for you should be discussed with your podiatric surgeon.
About the Author: Dr. Burton S. Schuler is a expert and authority on the human foot. He is a foot care specialist, podiatrist, foot doctor of Panama City, Panama City Beach Fl,. He graduated the New York College of Podiatric Medicine in 1975, and has been in private practice for over 38 years. He is an authority on the human foot and has written two books and hundreds of articles about the foot published in numerous podiatric journals and publications. He is this country’s leading authority on the Morton’s Toe, ((Long Second Toe) and its associated medical and health problems. His, first book about the Morton’s Toe, Why You Really Hurt: It All Starts in the Foot published in 2009 is the leading authority on the Morton’s Toe. And presently has 7,000 copies in print, and sold has thousands of copies the eBooks ( Kindle) on Amazon. The book is published by the La Luz Press, Inc and is disturbed nationally by the Cardinal Publishing Group. Dr. Schuler’s next book about the Morton’s Toe, called the Morton’s Toe Book will be published the last quarter of 2013 also by the La Luz Press. In 1982, he published his first book, The Agony of De-Feet: A Podiatrist Guide to Foot Care. During his thirty eight year career, he has written for Collier’s Encyclopedia and has been interviewed by The New York Times, Cosmopolitan, and First in Women. Dr. Schuler has appeared on dozens of radio and television programs both here and aboard. He is a Diplomate of both 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. He has been a professional member of the American Diabetic Association for about 35 years. . His professional and civic accomplishments have earned his inclusion in the 1999-2002 Who’s Who in America (Marquis) Here is a video review of Dr. Schuler and his book Why You Really Hurt: It All Starts In The Foot.