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Saturday, April 23, 2011

Big Toe Length Differences and What It Means

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Here the left big toe is clearly longer. This is called the Egyptian Foot in Ballet and leads to too much pressure in the big toe joint over time. If you imagine a dancer on pointe with this long first toe trying to balance and finding it very difficult. This foot type occurs in about 10% of the population.
See the long second toe in this patient.

Here is an xray of the most common foot, the Grecian Foot, with the long 2nd toe and 2nd metatarsal. The measurement taken means nothing, but the line straight across from the 2nd joint shows the typical 3 or 4 mm shorter length of the big toe. This is actually crucial in gait during propulsion, or AKA push off, to have the big toe shorter than the second so it can plantarflex or drive into the ground to lift up to 10 times body weight. This Grecian Foot occurs in 70% of the population.

Another example of the Grecian Foot with the long second toe and metatarsal. This also is not perfect for ballet since the ground reactive forces pushing back on the second toe causes it to eventually buckle and cause a hammertoe.

Here is my case study of Paige. Paige has the Egyptian Foot. She presented to my office with severe pain around the big toe joint and I feared she broke something, especially the sesamoids. She how long the first metatarsal is. In propulsion, the first metatarsal has a harder time plantarflexing (pushing down into the ground for pushoff) because it is already jammed into the ground before pushoff begins.

Again, Paige's numbers mean nothing, but you can see that in relationship with the 2nd metatarsal, the first metatarsal is not 3 mm shorter, but actually 4 mm longer. This is a 1/4 inch too long. Paige will have to use some form of Dancer's Pads for activity forever to balance these forces.


Here is the happy news I gave Paige yesterday. She had not broken her sesamoid, the sesamoid is seen under the first metatarsal. The MRI showed how inflammed the joint was, but the bones were doing well. She is taping the joint, icing, contrast bathing, dancer padding, and eventually I will design some orthotics to off weight the area  more custom made.

This is close to the final type foot, The Peasant Foot. It is where the first and 2nd toes are the same length. It is the ideal foot for ballet in this regards (there are other foot properties that make a foot good or bad for ballet). Even pressure is exerted at pushoff through both these key metatarsals and toes. I have not done enough research to know if it also gives an advantage to walkers and runners like th Grecian Foot does. Sorry Paige, but with alittle padding you can have the same function and comfort as the Greeks do.

2 comments:

  1. My 12 year old son's toe is about one and half inches longer than his second toe. I keep waiting for the others to catch up but they haven't. The big toe just keeps growing! Is this unusual?

    ReplyDelete
    Replies
    1. It is very uncommon, but not rare. It makes shoe buying a hassle. His feet will continue to grow until he is 14-15, but the toe pattern will probably remain the same. If it is on only one side, then x rays are in order. When the big toe is longer, the first metatarsal is longer, and he should probably have inserts to make sure the weight distribution is even in this foot. A long first metatarsal typically means more pressure on the ball of the foot. See a podiatrist for a discussion. Hope this helps some. Rich Blake

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.

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