Tuesday, December 6, 2011

Morton's Toe and location for the insert

Your chronic pain is real and does have an explanation.

(Did you know that you can hold down the control key and spin the wheel on your mouse and it will enlarge or shrink the image on your computer screen? Use this "trick" to make the image to the left larger.)
This is a picture of a typical foot (mine) with a long second metatarsal (The long bone that the toe attaches to). Notice that  the notch between the big toe and the second toe is much deeper than the notch between the second and third toes. This genetic condition is called Morton’s toe, after the medical doctor Dudley Morton. Lots of people, doctors, chiropractors, podiatrists and other health care professionals have heard of Morton’s neuroma. It is a completely different condition named after another Dr. Morton. Interestingly, the first condition (Morton’s Toe) may actually be the cause of the second condition, (Morton’s neuroma). Morton’s neuroma refers to an inflamed nerve between the distal ends of two adjacent metatarsals. Morton’s toe refers to a first metatarsal that is shorter than the second metatarsal. Most often, the second toe is also longer than the first (big) toe.

Dr. Dudley Morton described Morton’s toe and the associated chronic pain conditions back in 1927. He noticed that most people with this condition walk with their toes pointed out (duck feet); some percentage (20% ?) walk  with their toes pointed in (pigeon toed). In both cases, male and female, the pelvis tilts abnormally which causes the rest of the spinal curves to become abnormal, which causes the head to be carried well forward on the shoulders and the shoulders to also round forward. All of this causes Myofascial pain throughout the body. If you have unexplained pain in your knees, hips, base of the neck, upper back, low back, shoulders … (any of this sound familiar?) your feet may well be the source.

It took five years, but Dr Dudley Morton eventually got a corrective device patented. You can make your own in less than 5 minutes for less than $5.00. Yep, all that money you (or your health insurance company)spent on your chronic pain could possibly have been saved by making and wearing an inexpensive shim under the ball of the foot just behind the big toe (see the white arrow).

Janet Travell was the personal physician for both Presidents Johnson and Kennedy while they were in office. She, now deceased, was the leading authority on Myofascial pain. She researched, mapped trigger points and co-authored the text book on trigger point therapy. Dr Travell fully understood the relationship between a long second metatarsal and chronic pain. She published over 100 medical articles. Isn’t it strange that so few people know about Morton’s toe and its’ relationship to unexplained chronic pain.

first learned about Morton’s toe and using a "mole foam" shim from the “Trigger Point Therapy Workbook” written by Clair Davies, a massage therapist.  The drawback to mole foam shims is that they crush flat pretty quickly and have to be replaced. I tried cutting and gluing 3-4 layers of inner tube together with Elmer’s rubber cement to create shims. That works pretty well, but is a little work intensive. I recently discovered heavy duty felt strips, sold in the hardware section of stores like Fred Meyers, to be used underneath furniture. Like mole foam, it has a sticky back, is easy to cut and place and lasts much longer than the mole foam shims. Use inner tube for durability; felt strips for convenience. Cut your shim so that it is only as wide as the ball of the foot directly behind the big toe. I like to make it between one and a half to two inches long so I  am certain to get the support needed under the ball of the first metatarsal. If your shoes have removable inserts, pull them out and put the shim underneath the insert. If shoes do not have removable inserts, you of course have to put the shim on top of the insole. If using the ¼ wide felt strips, most people will need 2 strips, side by side. Remember, if your insole is removable, the shim will be more comfortable if you put the strips underneath, but placed so the same area is supported..


  1. This has been an easy change, Richard I have had so much improvement this week...after a month of non-stop pain. I am almost pain-free, an old bruised feeling in my shoulder as opposed to not being able to lift my arm to brush my teeth a mere few days ago. Thank you!!!! -Jill

  2. A good book to read on this subject is written by Burton S Schuler. He is a podiatrist in Panama City, Florida. His website is footcare4you.com

    Titled "Why You Really Hurt It All Starts in the Foot". The book also details how to make the corrective pad.

    Schuler describes that having a short first metatarsal bone creates a balance problem in the foot. It is common that people that have this also have a additional webbing between second and third toes.

    An easy way to make a pad is to buy a pair of heel grips that fit in the back of shoes to keep the foot from sliding side to side. I found them at Dollar Tree for $1.00 for package of 2 pads.
    Cut each pad into a strip 1" wide x 2 1/2" long. Attach to bottom shoe insert under the first metatarsal bone behind the big toe.

    What I now use is 2mm sticky back foam sheets found at craft stores such as Hobby Lobby or Craft Warehouse. The sheet is 9"×12". I use a Fiscars rolling paper cutter to cut strips. Cut to 9"×10". Cut 9 stips 1"×10". Then cut 4 strips out of each 10" strip 1"×2 1/2". Double up the strip thickness to 4mm. Each 10" strip makes a pad for a pair of shoes. Cost is about a dollar for sticky back foam sheet.