Morton's Foot And Back Pain

Morton's foot is a condition where the second metatarsal is longer compared to that of the large toe. More precisely, the large toe is actually congenitally short and that gives the appearance of a longer second toe. This condition is considered to be a normal variant.

When a Morton's foot exists, then as one propels off the forefoot, as in walking or running, there is excessive weight transferred to the second metatarsal head as opposed to the large toe.

This will cause repetitive trauma producing inflammation and pain. Then in an attempt to avoid the painful action of walking or running the foot is turned outward. This will cause excessive pronation and other associated reactions by the lower extremity, the hips, pelvis, low back and even up to the cervical spine.

Women seem to be more predisposed to pain from Morton's foot. Possibly because women tend to choose shoes more for fashion than function and proper support. The shoes will often have a narrower box, higher heels and minimal medial support. This will all further contribute to or aggravate a Morton's foot thereby increasing pain and inflammation.

How To Diagnose Morton's Foot

Diagnosis is very simple but often missed. Examination/evaluation should include: observation, history, footwear assessment and palpation.

Morton's Foot showing short first metatarsal heal from top view.
Morton's Foot showing short first metatarsal heal from bottom view.

How Does It Effect Lower Back?

As already mentioned there may be over-pronation and pes planus present. When Morton's foot is present, the over-pronation will be exaggerated as one flares the foot outward in an attempt to avoid pain. This outward flaring will cause more medial rotation of the knees, hips and ankles.  A pelvic tilt will  often occur to the affected side, which will cause tightening and shortening of the piriformis, hamstrings, quadratus lumborum and psoas muscles. The are the major muscles of the lower back, pelvis and hip.

All of this will cause the lumbar spine to rotate and hyper-extend. If facet joints are already arthritic and degenerative then there will be further aggravation and micro trauma, weakening of the discs that predisposes them to bulging or herniation and nerve pressure from direct bony compression, muscle tightness and disc bulging.

If the lumbar spine was not already dysfunctional and structurally abnormal then failing to correct a Morton's foot will eventually make it so.

Aside from the pain and disability, one may also suffer financial expense due to healthcare costs associated with treating acute, recurrent or chronic conditions

What Is The Solution?

  • Be fitted with proper footwear -- high heeled shoes and narrow shoes may be particularly troublesome

  • Apply cushioning or padding under the large toe metatarsal head to make it more weight bearing and to reduce stress on the second metatarsal head
  • Avoid running, jogging and excessive pressure until adequately treated and pain permits
  • Inflammation must be treated appropriately with ice and possibly anti-inflammatory over-the-counter medicines or in severe cases it may require prescription drugs temporarily.

On the right are a few examples of common shoe styles for women. The two styles on the right will be the most troublesome for those suffering with Morton's foot inflammation. Avoid these two as much as possible. They will also cause or contribute to bunion formation, metatarsalgia, and even lower back pain.

women' shoe syles that may cause or aggravate morton's foot inflammation, bunions, metatarsalgia, and lower back pain.

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