2nd Toe Problems: Email Advice

Hi Dr. Blake,

I'm not sure if you remember me, but I am a former patient of Dr. Hannaford's and after he retired, you helped me adjust a semi-custom orthotic he made for me for running. I was reviewing your blog because I'm having a 2nd toe issue but the page I want to access keeps directing me somewhere else. I am hoping you may be able to help over email?

My right 2nd toe is swollen and a bit warm to the touch at the tip part (to the first bend). There are no cuts, I didn't jam it. Walking is ok, I can feel it is a little swollen but it doesn't really hurt. Oddly a little itchy yesterday but ok today. There have been a couple times while running that I've felt something strain a bit but it's more towards the bottom of the ball and it quickly goes away. Should I make an appointment to see you? Or just take ibuprofen for now? I do think I should have my orthotics looked at again and adjusted. I'm starting to get a small callus on the ball of my foot in between where the big and second toe align.

Thanks in advance for any advice you can provide.

Dr. Blake’s response: Thanks for the email. The primary culprit would be a slight ingrown toenail that can fester for months. The second culprit would be some soft tissue irritation if the second toe is your longer toe (Morton’s Syndrome). Yes, it would be good to see you and perhaps make some room for that toe by adjusting the padding on the orthotic devices. You can make sure that you have the correct size of shoe by standing and see if you have a full thumb width length to the end of the shoe. You can remove the shoe’s insole (if possible) and check where the impression is for the 2nd toe (say closer to the end of the insole than the uninvolved left one). If you have been walking a lot lately, and there are a lot of downhills to walk, the 2nd toe if longer can just be sliding forward in the shoe even if the correct size shoe. Some of my patients buy a medium foam toe cap to put over the 3rd toe to make sure the 3rd toe is taking a little more pressure always from the second. Other patients have bought a small toe crest (there are individual for the right or left side) and placed the loop for the 3rd toe to lift the 2nd off the ground. Make sure you cut your nails a little shorter than normal to see how that works. Try a week of a 30 minute warm water soak each evening to pull out some inflammation. I love that over drugs. Hope some of these ideas help. Rich