Cross over toe is a condition where the second toe drifts toward the big toe and eventually crosses over and perches on top of the big toe. Crossover toe is a common condition that occurs at any age, although it is most often seen in adults.
Crossover toe is usually a result of abnormal foot mechanics, where the ball of the foot beneath the second toe joint receives an excessive amount of weight-bearing pressure. This pressure eventually leads to weaken supportive ligaments and cause a failure of the joint to stabilize the toe, resulting in the toe crossing over. Certain conditions or characteristics can make a person prone to experiencing excessive pressure on the ball of their foot. These most commonly include a severe bunion deformity, a second toe longer than the big toe, an arch that is structurally unstable, and a tight calf muscle.
Although the crossing over of the toe usually occurs over time, it can appear more quickly if caused by injury or overuse. Symptoms may include:
Crossover toe is a progressive disorder, meaning it is crucial to identify it and treat it as early as possible (when pain is present but no visual crossover of the toe). If it is not treated, the condition usually worsens.
Once the second toe starts moving toward the big toe, it will never go back to its normal position unless surgery is performed. The foot and ankle surgeon will select the procedure or combination of procedures best suited to the individual patient.
The basis for cross over toe surgery most often involves removing a portion of bone within the toe itself to achieve reduced joint contracture. The toe will also need to be relocated at the joint of the ball of the foot, with potential to undergo additional bunion surgery to make space for the relocated toe.
Repairing the buckled digit is the first phase in cross over toe surgery. The two most common methods surgeons use to correct the contractures are joint resection (arthroplasty) or bone mending (fusion).
The second phase of a cross over toe surgery is performing a joint relocation procedure at the joint of the ball of the foot. Sometimes, the ligament on the bottom of the foot will need to be repaired. If the toe is severely dislocated, a bone shortening procedure will be needed to return the toe back to its original position. A surgical wire is inserted to keep the toe stable and steady during the healing process.
The third phase of cross over toe surgery is correcting the bunion problem of the big toe. It’s vital to recognize that most of the surgical work involve the toe’s joints, not the joint of the ball of the foot. Sometimes a toe relocation procedure is required when the joint of the ball of the foot is misaligned.
The timetable for full recovery after cross over toe surgery ranges from six to twelve weeks, depending on just how severe the toe deformity was before surgery took place.