My Toe is Crossing Over

The second toe is the most common toe to dislocate in the forefoot. The plantar plate at the second metatarsophalngeal joint can become unstable and rupture causing pain, swelling and subluxation or dislocation of the toe. The plantar plate attaches the bottom of the metatarsal (long bone in the foot) to the base of the proximal phalanx (toe bone) and prevents motion in the sagittal plane and absorbs shock while ambulating. It is a major stabilizing structure and when damaged can lead to a crossover toe.

Plantar plate tears are caused by trauma, inflammatory arthropathy, and repetitive hyperextension commonly caused by excessive wear of high heels.

Patients often complain of pain and swelling on the bottom of the toe. Without treatment the deformity can progress and the second toe can cross over the big toe making it difficult to wear shoes.

Our physicians at

Foot& Ankle Doctors, Inc

will perform an anterior draw test, which is pathognomonic for an unstable metatarsal phalangeal joint. Ultrasound, x-ray and MRI are other diagnostic tests that may be ordered to determine the severity. Conservative treatment includes:

-Rest

-Ice

-NSAIDs

-Taping the toe in a plantarflexed position

-Accommodative padding to reduce pressure under the affected toe

-Stiff-soled shoe or rocker-bottom shoe

-Custom orthotics

In severe cases the plantar plate may need to be surgically repaired. The plate itself may need to be sutured or a metatarsal osteotomy performed to shorten the second metatarsal.

If you are having pain in your toes, come see us at

Foot& Ankle Doctors, Inc

Giants Tight End Fells Tackled by Small Bug

New York Giants tight end, Daniel Fells may loose his foot after suffering from a serious MRSA infection. MRSA is a type of staphylococcus infection that is resistant to methiciliin antibiotics. It is a common superbug and is contagious spreading from one person to another. The Giants have taken precaution to prevent the spread of the bug to other players by complying with infection-control protocols. MRSA can enter through a break in the skin barrier causing infection that may enter the bloodstream and affect major organs or bones.

Fells reportedly received a cortisone injection for a toe injury that may have inoculated the bacteria into his body. Anytime a foreign object such as a needle is placed into the body, there is a risk of infection. The risk is low, but there is always a risk. Fell has undergone multiple surgeries to stop the infection and save his foot. If the infection has spread to the blood, Fells will need a course of IV antibiotics.

MRSA often presents as a skin infection and can be mistaken for a pimple or spider bite. The skin will become red, swollen, painful to the touch, and filled with pus. It may be accompanied by a fever, and has the potential to become a life-threatening infection if left untreated.

All of us at Foot & Ankle Doctors, Inc. wish Fells a full recovery.

Dr. Nejad

Chronic Ankle Pain – Os Trigonum Syndrome

Ballet dancers, soccer players and individuals who frequently plantarflex their foot (point their toes downwards) may experience chronic ankle pain located at the back of their ankle. Os trigonum is an accessory bone located on the lateral process of the talus – the back of the ankle. Most individuals are unaware they have an os trigonum until it becomes symptomatic. Severe plantarflexion can cause the accessory bone to become crushed between the ankle bone and the heel bone. This motion results in injury to the ligamentous attachments of the accessory bone leading to pain and swelling. Individuals complain of a deep aching pain at the back of their ankle when walking or when pointing their foot.
Conservative treatment options include:

  • Rest to allow the inflammation to subside

  • Immobilization with an ankle support/brace/ boot

  • Ice to decrease swelling

  • NSAIDs such as ibuprofen to help reduce pain and inflammation

  • Corticosteroid injection to reduce inflammation and pain

If conservative treatment fails to alleviate symptoms, surgical excision of the os trigonum may be necessary.

If you or a loved one is experiencing chronic ankle pain, come see us at Foot & Ankle Doctors, Inc.

Dr. Dardashti