Rothbardt’s foot, or, Morton’s toe

Welcome! Forums Running Forum Rothbardt’s foot, or, Morton’s toe

This topic contains 40 replies, has 9 voices, and was last updated by  Posturepro 8 years, 11 months ago.

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  • #11545

    raffie
    Member

    This is for any serious runner with what is typically called “morton's toe,” where the second toe is longer than the first, and which results in late stage pronation. All gait analyses I've had, in specialty running stores in Atlanta, and in Boulder, show I'm neutral to even supinating a bit on the left foot. However, my shoe insoles show a deep indentation at the base of the second metatarsal, which clearly means I'm not getting effective toe off, and am in “late stage pronation,” where the first metatarsal drops at the last minute before toe off. I've tried cutting a Dr. Scholl's moleskin pad and putting it under the big toe only (if it's under the second toe, it makes the situation worse. )That has helped some, but there is still a degree of late stage pronation. Ive also tried orthotics, with a morton's extension, but I don't think it was thick enough to really correct the problem. Apparently, there is a company that has come out with an athletic insole just for morton's toe called “prokinetics.” But I'm not sure they're available yet. In any case, has any other runner who has this condition found a way to correct this problem? Thanks for any thoughts.

    raffie

  • #27848

    denton
    Member

    …question…are u getting injured from your morton's toe??????My general take would be more along the lines of doing hip/core work that deals with any foot biomechanic issues in a more proactive manner….

    a good article my chiro sent me on orthotics (now i should oreface this by saying i waer them, but i have a reverse norton cutout that is based upon this type of research/idea:

    https://web.archive.org/web/20101017045250/http://www.somaticsenses.com:80/article/?p=59

  • #27849

    ed
    Participant

    How much of a problem is this condition actually causing you? 

  • #27850

    raffie
    Member

    In response to both your questions, the fundamental issue, aside from a little pain on the base of my second toe, is the lack of an efficient toe off. It is difficult to get a good push off from the first toe because it collapses at the last moment before toe off, forcing toe off from the base of the second toe. I guess that's call late stage pronation, and I don't otherwise pronate (or I don't think so, based on the many gait analysis I've had done). The power that most people have at “big” toe off is just not there. I'm experimenting with increasing the mm. height to 3 under the base of the second toe on my orthotics. And, if the prokinetic insert is available – it's about 3. 5 mm I think, then I'll try that too. 

  • #27851

    denton
    Member

    i will add this…..be careful of old school orthotics (egs rootian ideals)…a 3 dimensional more modern approach (finding the route of least resistance as opposed to forcing u into what is coined the perfect foot plant is simply unrealistic….)

  • #27852

    rehammes
    Member

    I have been reading quite a bit lately on Newton running and Chi running which would suggest that the toe-off or power running mechanics increase the likelihood of injury to the feet, ankles, knees and lower back.  Like Denton said, maybe review your biomechanics a little to see if a midfoot strike wouldn't solve any discomfort.

  • #27853

    raffie
    Member

    I am already a midfoot to forefoot striker, so I don't think that is the issue. As for orthotics, the minimalist approach may work for some, but with this particular condition, I can't see any way to stop the late stage pronation EXCEPT through raising the ground up to the big toe with some sort of device; it doesn't have to be orthotics. I love minimalist shoes with a low heel, by the way. I hate running shoes with high heels as that forces heel strike first, which is very inefficient. So the orthotics I have have a cut away heel.

    Thanks for the posts

  • #27854

    denton
    Member

    …are u finding you aren't going thru a full gait???? or simply lacking toe off power???? Morton's toe is a pretty common occurrence, so I'll assume you've worked in the various 'biomechanical' health areas (egs chiro, physio, sports med, podiatrist, pedorthist, etc…..) who actually have some semblance of your areas of concern….as opposed to 'joe blow' physio who deal with avergae 'joe blow' injuries …egs not running oriented….

    I am lucky as i have a handful of those people who work at the Olympic level i can turn to when i need to go beyond the tradititonal approach of 'here put some ice on that injury and we'll ultrasdound u later' approach……they are unfortunately extremely difficult to find

    …u may want to post on letsrun.com and ask Brian Fullem (a runner who is also a podiatrist) about his opinion as opposed to those of us with only a basic background….he also has a webpage and typically is very open to offering some ideas for u to consider….

  • #27855

    raffie
    Member

    Denton,

    thanks very much for your insights. I'll try to follow your suggestions. And I'll let you know what I find out. I'm headed to Aseville, N.C. today for a few days of r&r/. Temperature is a relative thing, and Asheville is 10-20 degrees cooler than the 95+ temps where I live and run in Georgia.

  • #27856

    Ryan
    Keymaster

    Raffie, whatever you find, I would be very interested to hear the results. Unfortunately, I can't offer anything in terms of advice on this beyond what has already been mentioned but I'd love to hear your results so maybe I can point to them in the future if someone else has the same question.

  • #27857

    raffie
    Member

    Ryan,

    Thanks for your response. At this point, the only insert specifically designed for controlling morton's toe is one from a company called pro-kinetics. It weights about 1.3 ounces, lighter than most orthotics. They've just finished the prototype, and the lift is about 3. 5 mm. But I'm not sure they're available for purchase yet. I think they're connected with a company that made inserts for walking shoes.

    I just tried the new orthotics, and, sadly, the lift doesn't keep the big toe from collapsing, though it does control that more than any other device. So, other than a Dr. Scholl's moleskin pad, that may be all that's there.

    Thanks for a great forum Ryan,

    Ralph

  • #27858

    sueruns
    Member

    morton's toe was my first trip to the podiatrist back in the 1980s.  The numbness had become severe enough that it ran up my entire hamstring and couldn't walk.  The orthotic didn't help. I stopped wearing heels at work and invested in shoes with wider toebox.  It's never returned, however, I've had alot of Big toe problems in the last couple of years, the podiatrist called it halllux limitus from years of pushing off my toes.  My options were pretty much the same as yours, cut the insert under second toe and stabilize big toe.  i hated it.  I was also having a 2 year problem with plantar fascitis, so the podiatrist gave me an insert with a raised heel.  To me, this didn't make an sense to raise up my heel when I'm already putting too much pressure on my toes……but the problem stopped and so did the PF.  I did have my gait analyzed after all these foot problems and they concluded that my running evolved to having higher cadence rather than a power off and it would take too many years to correct, and maybe wouldn't want to as high cadence is a good thing.

  • #27859

    raffie
    Member

    sueruns,

    thanks for the additional information. I guess that even for those with the same condition, different remiedies might work. If I don't have a lift under the first toe, all the pressure goes to the base of the second toe. For me, I'd prefer a low heel, and  push off from the big toe first. I'm surprised a higher heel works for you, but “different strokes……….”

  • #27860

    denton
    Member

    geezz sue…you're like a catch 22…..what works for morton's toe is the opposite for a hallux limitus……

    …raffie raised heal is standard for trying to get a shorter stride and less time spent on foot plant for hallux limitus

  • #27861

    ed
    Participant

    I never really looked at me feet before with the idea of toe lengths compared to other toes on my feet.  I looked closely in the shower this morning and my second and third toes are slightly longer than my big toe by about an eighth of an inch (not counting any nail lengths.)

    I do not experience any noticeable pain or discomfort in my feet except after a mid-length (or better) run of 7 miles or more and that slight soreness is at the tip of the third toe. 

    I do not think that the slightly longer toes cause an issue with toe-off because the strength of the bottom of a running shoe likely makes up for that eighth of an inch difference.  But then again I do not know becuase I have never paid attention to this possible issue. 

    I have bigger issues to address than this for me right now but it is something to keep in mind especially if discomfort seems to increase as I increase the miles and overall consistency in my running.

    But thank you for bringing this issue to this forum – I would have never heard of it otherwise.

  • #27862

    raffie
    Member

    Denton and Ed,

    Thanks again for posting. Denton, as for the high heel, I've never been able to deal with them. They cause me to hit heel first, and I've always been a midfoot to forefoot striker. My stride is more of a loping one than a high cadence one, I guess, but since I'm 6 ft. 2 in., that seems normal to me.

    Ed, maybe you're lucky. My problem is that, without a big toe lift, all the pressure and first contact point is at the base of the second toe (aside from being inefficient, there are big calluses there too.) Such is life (running, that is).

  • #27863

    ed
    Participant

    Maybe hight (and therefore stride length) has something to do with it – I am only 5'7″ and would have a shorter stride length than you.

  • #27864

    raffie
    Member

    Ed, perhaps you're right, though  I have read of some tall runners having a short cadence and some relatively short runners (Bill Rodgers,5 f. 9 in) having a longer cadence.

  • #27865

    Ryan
    Keymaster

    Don't fall into the mistake of thinking that stride length or stride rate are so closely related to height. It's pretty well established that stride rates among well trained runners are remarkably similar regardless of height and, as a result, stride length has a more direct correlation with pace than anything else.

  • #27866

    ed
    Participant

    Raffie –

    Do you have only the one toe longer than the big toe?  Also, how much of a difference in length is there?

  • #27867

    denton
    Member

    raffie…my 'shorter stride' comment was more related to hallux limitus…they've found that a shortening of the stride tends to alleviate some of the gait issues with it…..(makes sense as hallux limitus makes one foot go thru the gait cycle quicker, so shortening/speeding up up the overall gait cycle would help the various mechanical issues with said problem….

  • #27868

    SF/John
    Member

    Hopefully this “may” clarify a few points.  The Morton's Toe (inherited trait) is NOT really a longer 2nd toe, but a SHORTER first toe (#1).  The foot will roll over (pronate) to get the shorter metatarsal head in contact with the ground.  I prefer to see runners in a lower heeled shoe (reduce pronation) and then you can adjust a Morton's Toe Extension.  All Morton's Toes are NOT the same degree of shortness.  It is wise to get your foot x-rayed so that you can see the visual evidence.  The Morton's Toe Runner is about 30-33% of the population, but about 70% of the injury list.  Each runner has to make his/her own adjustments, but I have seen very good runners (Olympians) with this condition.  We also may look at the entire kinetic chain to see if there are things that may aggravate the condition.

    Sue, the reason the higher orthotic solves the PF question is because the short calf muscle is the root cause.  The pronation aggravates the condition, but the higher orthotic seems to relieve the stress in the calf muscle.  I would try a pair (slowly) of the Newtons to see if you can get the calf to elongate and become more effective in your gait cycle.  One question for you.  Do you have a higher hip?

  • #27869

    raffie
    Member

    Ryan, Ed, Denton, and SFJohn,

    Ryan, I do understand that a 180 footfall cadence is what is desired over a shorter or longer stride.
    Ed, both big toes are shorter than the second one, the left one even more so, even though I seem to pronate more on the right foot (leg length discrepancy)
    Denton, you are correct about the gait cyle and the higher heel; that makes sense

    SFJohn is right on the mark about a low heel reducing pronation (he's answered many of my questions in the past in other boards, and he is always correct). SFJohn, I've always wondered about some Olympians who may have had this condition. Seems like I remember Frank Shorter having something like this, and he tried to control it with taping his arches up.

  • #27870

    Ryan
    Keymaster

    Ralph, just for the record, I'm not trying to suggest a cadence. The ideal cadence for each of us is going to be different for many reasons and one's own ideal cadence will more likely than not change over time. I just wanted to address the common misconception I saw pop up here that height/leg length is directly tied to cadence/stride length. There may be some small correlation but there are much more significant factors.

    As I think John is kind of touching on, any difference in severity of the problem is very likely related to the degree of length discrepancy, as well as other biomechanical factors.

  • #27871

    raffie
    Member

    Yes, I undertood your point. This is a tricky problem, with variations depending on the imbalance.

  • #27872

    tmvaughn
    Member

    My son is a running back in football.  We are trying to correct his running form.  He runs with his on his heels or flat footed.  He also keeps his shoulders back to the pount his shoulder blades are touching and little arm movement.    We took him out this weekend and video taped his running.  His left foot point outward.  As he is bringing the right foot around the the bottom of his foot is pointing inward.  He strikes the heel first with the toes pointing high in the air.  He does not have a strong push off of the ball or toes.  His 2nd toe is longer than the big toe but I have not physically felt the metatarsals yet.  He is complaining of his heels hurting but his calves are very tight.  We have been working on massage and trigger points which is helping some.  His running form does correct some after resistence training but he does not maintain the form.  Any suggestions?  I have video of him running if that would help.

  • #27873

    SF/John
    Member

    He is getting the start of PF.  The “root” cause is the tight calf muscle.  He will need a “slant board” to create a negative heel.  He also “may” need a Morton's Toe extension for that first metatarsal head. He should use a thera band or old bike inner tube for dorsiflexion and plantar flexion.  Let him try a couple of barefoot grass runs to see how  it feels.  A little at a time.

  • #27874

    ed
    Participant

    SF / John –

    Thank you so much for your medical advice on these forums – it is truly appreciated. 

  • #27875

    sueruns
    Member

    Hopefully this “may” clarify a few points.  The Morton's Toe (inherited trait) is NOT really a longer 2nd toe, but a SHORTER first toe (#1).  The foot will roll over (pronate) to get the shorter metatarsal head in contact with the ground.  I prefer to see runners in a lower heeled shoe (reduce pronation) and then you can adjust a Morton's Toe Extension.  All Morton's Toes are NOT the same degree of shortness.  It is wise to get your foot x-rayed so that you can see the visual evidence.  The Morton's Toe Runner is about 30-33% of the population, but about 70% of the injury list.  Each runner has to make his/her own adjustments, but I have seen very good runners (Olympians) with this condition.  We also may look at the entire kinetic chain to see if there are things that may aggravate the condition.

    Sue, the reason the higher orthotic solves the PF question is because the short calf muscle is the root cause.  The pronation aggravates the condition, but the higher orthotic seems to relieve the stress in the calf muscle.  I would try a pair (slowly) of the Newtons to see if you can get the calf to elongate and become more effective in your gait cycle.  One question for you.  Do you have a higher hip?

    my previous massage therapist also babbled about my hip rotated forward….I actually have felt forward rotated on right side after having along layoff this fall.  I had a gait analysis done 3 years ago and the PT reviewed my tapes and said I drop my hip after landing…his reasoning was that I had evolved this style because my calves are very big for a relatively small woman (37.5 cm), my right hip drops so the calf passes at the bent knee rather than trying to slide by the other fat calf.

    a friend has strongly suggested Newton's to me, he said my fulcrum (again, the big calves) is too heavy.  >:(

  • #27876

    raffie
    Member

    Ryan, you asked me to tell everyone of my experience with this so here it is.

    Maybe my experience will be different than others', but I tried the prokinetics insert for morton's toe and didn't have a lot of success. First, the sizes they come in, for each insert, are one and a half size, like 9 to 101/2, 101/1 1o 12. So, it's not a good fit. One can cut it, but it's not a sure bet. Also, when I first got them, I ran in them, and felt an irritation on the  base and top of my big toe. I emailed the staff, and they recommended a higher toe box shoe, so I tried out 8 pairs of shoes trying to get the right fit, and the arch support on the right insert somehow fell off and was lost. The staff is not very customer friendly, and told me they were sorry I lost the arch, but they only send out full insert kits. So I didn't get a chance to rreturn them, or to run in them enough to recommend them. My only option, therefore, is to cut Dr. Scholl's moleskin pads – the thick ones – into a rectangular shape and place two of them under my running shoe inserts at the big toe (and it shouldn't go under the second toe, as that makes the condition worse) Maybe they will last as long as the shoe itself.

  • #27877

    SF/John
    Member

    I will try to give a couple of suggestions.  Ralph first I would leave it alone unless you are having injury problems.  If you are having injury problems these are methods I have seen work.  We take a flat spenco Insole glue it on top of the orthotic, or arch support.  We then add a piece of rubber to elevate only the #1.  You can go at this by starting high and grinsding down, or start a little low and build up.  Second I have seen relief by adding a small 1″x1″ piece of cork/felt to the medial corner/front of the orthotic (underneath) the height is a variable and you have to be creative.  Third some Morton's Toe Runners like a low-heeled curved lasted shoe because they feel that their big toe is in ground contact.  We understand that this foot type will generate varying forces up the kinetic chain.  One of three things happens, better, worse, same.  We can add a small amount of felt to the arch and the runner may feel it in his/her back,butt, hamstring,calf, ankle, etc.  This is still a trial and error method.  As I said at the start if you are unijured I would leave it alone.

    Sue, what you are describing is “lateral pelvic tilt.”  Some of the old school professors have claimed that this is the root cause of all the running injuries (or most of them).  The short side is normally the dominant side (stronger).  The high side is usually weaker (not always).  We x-ray you barefooted, STANDING.  We are looking for any signs of hip misalignment (dysplasa).  We test strength and balance.  Strength with one leg presses and one leg squat.  Muscle imbalance with a squat bar to see if you do a squat does the bar tilt?  We can try to strengthen the weak side and stretch the strong side.  Some runners find that a small (less than 1/2 ) the shortage helps them in the transition phase.

    I would strongly suggest that you  have a friend videotape you running especially front and back.  If we run you at a track with lane lines bisecting your body, can you hold the line, or do you wavier.  If you waiver there are imbalances.  It may be strength,, range of motion, flexability, or all them.

    Sue, I have suggested trying on a pair of Newtons.  If possible you might want to try a pair of MBT shoes to see how you feel with a different alignment.

  • #27878

    raffie
    Member

    Thanks John, I'll give these ideas a try, and let you know.

  • #27879

    raffie
    Member

    p.s. John, I love low heeled, curved lasted shoes too

  • #27880

    Ryan
    Keymaster

    Thanks for the update. It's good to hear some first hand experience. Maybe your experience is normal, maybe not, but one thing is sure. Your experience will not be represented in the usual testimonials.

  • #27881

    sueruns
    Member

    I will try to give a couple of suggestions.  Ralph first I would leave it alone unless you are having injury problems.  If you are having injury problems these are methods I have seen work.  We take a flat spenco Insole glue it on top of the orthotic, or arch support.  We then add a piece of rubber to elevate only the #1.  You can go at this by starting high and grinsding down, or start a little low and build up.  Second I have seen relief by adding a small 1″x1″ piece of cork/felt to the medial corner/front of the orthotic (underneath) the height is a variable and you have to be creative.  Third some Morton's Toe Runners like a low-heeled curved lasted shoe because they feel that their big toe is in ground contact.  We understand that this foot type will generate varying forces up the kinetic chain.  One of three things happens, better, worse, same.  We can add a small amount of felt to the arch and the runner may feel it in his/her back,butt, hamstring,calf, ankle, etc.  This is still a trial and error method.  As I said at the start if you are unijured I would leave it alone.

    Sue, what you are describing is “lateral pelvic tilt.”  Some of the old school professors have claimed that this is the root cause of all the running injuries (or most of them).  The short side is normally the dominant side (stronger).  The high side is usually weaker (not always).   We x-ray you barefooted, STANDING.  We are looking for any signs of hip misalignment (dysplasa).  We test strength and balance.  Strength with one leg presses and one leg squat.  Muscle imbalance with a squat bar to see if you do a squat does the bar tilt?  We can try to strengthen the weak side and stretch the strong side.  Some runners find that a small (less than 1/2 ) the shortage helps them in the transition phase.

    I would strongly suggest that you  have a friend videotape you running especially front and back.  If we run you at a track with lane lines bisecting your body, can you hold the line, or do you wavier.  If you waiver there are imbalances.  It may be strength,, range of motion, flexability, or all them.

    Sue, I have suggested trying on a pair of Newtons.  If possible you might want to try a pair of MBT shoes to see how you feel with a different alignment.

    this all makes sense…i 'know' i waiver…..would it be consistent that i actually lean into the high, nondominant side.  When things are really out of whack, my arm on the dominant side crosses way over my midline and when i run next to someone.  I actually share office space with a PT that videotapes gait, probably should have had her do it awhile ago.

  • #27882

    raffie
    Member

    I'm aware that Saucony Guides and Tangent are low heeled shoes. Maybe the Puma Eutopia is also, though I've not worn any of them. It's very hard to find a trainer, or even a racer these days, with a minimal heel. Any suggestions?

    thanks again

    ralph

  • #27883

    SF/John
    Member

    Sue, sorry I was not clear in the previous response.  The 1/2″ or less is for a heel lift.  The arm swing is a “balance” issue.  It swings to compensate for the “imbalance.”  You can try the squat (using a spotter or PT) to see if the bar dips to one side.  You will “pull” on the dominant side especially at higher speeds. Test for side-to-side muscle imbalance/strength ratio.

    Ralph, there isn't any way that I can tell you if the models you listed are low enough.  This is indivdual,  trial and error method.  I will caution you if it is not broken leave it alone.  I have had customers come in wearing Converse Hi-Tops they were happy, and  unijured.  They left in Converse Hi-tops.

  • #27884

    raffie
    Member

    Thanks again John, trial and error it will be. I don't get injured very often, but my mt condition does prevent an effective toe off. As for the arm swing thing, I have a big arm swing on my right elbow, and I'm sure it's because of a leg length discrepancy, but it hasn't caused any running injuries or injuries.

  • #27885

    SF/John
    Member

    Ralph,

    Everyone with a Morton's Toe will torque over at push off it is due to the short #1 metatarsal head.  You have to roll over to get the met head in contact with the ground.  Leg shortage is most likely due to pelvic tilt.  Same thing I gave to Sue test one leg at a time for strength ratio.  If injury history get a standing barefooted x-ray.  If there is a misalignment we then start with a very small lift.  We NEVER correct more than 1/2 the shortage.  If you are still in NC make a stop over at Zap Fitness (Blowing Rock) it will worth your time.

  • #27886

    raffie
    Member

    thanks again John. I'm trying the cork, and will get a pt or chir. to help me determine the discrepancy, and correct lift. As you say, I will keep the lift so that it's not above 1/2 the discrepancy.

  • #27887

    Posturepro
    Member

    One of the early posts on this topic refers to a company that is in the process of developing special insoles for morton's toe.  We have actually made these insoles for 8 years, and if you want to learn more about them, I suggest you visit our websites http://www.ProKinetics.com or http://www.PostureDynamics.com.  The Morton's toe condition is also referred to as Morton's Foot Syndrome.  The real problem is an elevated first metatarsal that does not properly support the foot and body.  The result is overpronation which also via muscular compensation leads to supination.  The bottom line is that these insoles work extremely well for both overpronators and supinators, and take care of most of your pain symptoms very quickly.  The list is long.  Here are a few:  Plantar Fasciitis, Tight IT bands, Metatarsalgia, Morton's Neuroma, Calluses, Ankle and Knee pain, Tight calf muscles, Hip and low back pain, Shoulder and neck pain.  The point here is that all of these pains are due to muscle overuse and joint misalignment.  You can call us for assistance too. 

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