Houston podiatrist Discusses overlapping and crossover toes due to bunions and plantar plate injuriesWhen we talk about a #HammerToe, we most often think about the buckling of the joints of the toes. The toes take on a hammer shape and can become painful. Sometimes the toe just doesn't pop up. There are times when the second toe will start reaching for your great toe and even sit on top of it. This is problematic. For one, your shoe doesn't have room for your second toe sitting on top of the great toe. Because of that, there's lots of pressure inside the shoes. It makes the toes crowded and painful. 

One reason for the second toe to sit on top of the great toe is because of a bunion deformity. A bunion deformity occurs when the first metatarsal bone rotates and causes a bump to form on the side of your great toe joint. What also happens is the great toe shifts over towards the second toe. This often causes the great toe to slide underneath the second toe. The second toe ends up being forced on top of the great toe. 

Treatment for this involves not just the procedure for this second toe that's a hammer toe, but you also need to have the bunion addressed. Think of it this way. If you correct the hammer toe on the second toe and the great toe is still underneath the toe, pushing it up, it's going to just do the exact same thing again. That's why a procedure needs to be done to correct the bunion deformity. This will straighten the great toe and stop it from pushing up the second toe. I recommend you check out my video series all about bunions for more information. 

Another reason that the second toe overlaps the great toe is because of a tear in a ligament beneath the joint between your foot and the toe. Every one of these joints has a capsule of ligaments that envelops the joint. The bottom part of the capsule is thickened, and we call it the plantar plate. A rupture of the #PlantarPlate weakens the support of the toe. The toe is no longer able to be held down in a corrected position. As a result of this injury, the toe pops up and shifts over towards the great toe. 

Here's the thing. The toe can go crazy and shift up and over without a plantar plate injury. So in order to treat this properly, I need to be able to see if the integrity of the plantar plate is intact, or if a rupture of the ligament is causing the problem. In order to assess the status of the plantar plate, I'll order an MRI. An MRI will allow me to examine the ligament to see if it's ruptured or not. This is very important to know, since the treatment for a hammer toe differs from the treatment of a plantar plate injury. 

If it's in the early stages of a plantar plate injury, it's possible for the ligament to heal. In that case, I would tape your toe to maintain it in a proper position for the ligament to heal. This may be effective if a torn ligament is due to and injury. For instance, let's say you trip over a curb. The next day, you see that your second toe is up and over your great toe. That's the perfect time to come into the office for treatment. I'll make sure nothing is broken and we'll show you how to tape your foot to get that toe back down. For an acute injury like that, taping is an effective way to reposition the toe and allow the plantar plate to heal. 

If taping is successful and repairing the ligament, I'll recommend the use of a custom orthotic afterwards. This will shift pressure away from an already weakened ligament to prevent future problems from occurring. Unfortunately, most plantar plate injuries are not because of trauma and aren't so easily solved. 

In most cases, they're plantar plate ligament progressively weakens over time. And when the ligament wears away and ruptured, well, think of it like a shredded rope, no amount of taping is going to allow it to heal on its own. Because of the position of the second toe, it's difficult to wear a shoe and the toe becomes painful. 

The best treatment for a plantar plate rupture is to repair it surgically. The surgical procedure to repair a plantar plate is involved. A surgical fracture is made in the second metatarsal in order to expose the torn ligament. At that time, the ligament is sutured and anchored to the first bone of the second toe. That's what brings the toe back into alignment. The fracture that I created in the metatarsal bone is then repaired with a screw. After the surgery, you'll be in a boot for a few weeks after, as well as having a dressing on your foot. Sutures typically come out in two to three weeks and you're usually back to full activity in eight to 12 weeks.