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Crossover second toe deformity common in women, related to first MTP joint arthritis

Researchers found that the drawer sign was the most reliable and reproducible physical exam for identifying the deformity.

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TORONTO — Crossover second toe deformities are found most in women older than 50 years of age, according to a study presented here. The deformities are also associated with bunion deformities and first metatarsophalangeal joint arthritis, the lead author noted.

Ari J. Kaz, MD, and Michael J. Coughlin, MD, reviewed the demographics, etiology and radiographic features of crossover second toe deformity in 169 patients treated surgically for the deformity over 6 years.

Kaz presented the results of the study at the American Orthopaedic Foot and Ankle Society 23rd Annual Summer Meeting.

Of the 169 total patients, 146 (86%) were women and 23 (14%) were men. Patients averaged 59 years of age at the time of surgery and had experienced symptoms for an average of 31 months preoperatively, ranging from 3 weeks to 40 years, according to the study.

"Even in those cases with a bunion deformity the primary complaint of patients is in regards to pain in the area of the second metatarsophalangeal (MTP) joint and bunion deformity is secondary," Kaz said.

The researchers found that 146 patients had clinical dorsomedial deviation of the second toe compared to the adjacent third toe. Also, 112 patients had a positive drawer sign.

"We have found the drawer sign to be the most reliable and reproducible physical exam finding to confirm second MTP joint instability," Kaz said.

Patients with a negative second MTP joint angle also had a three-fold increase in first MTP joint arthritis, he noted.

"We believe this is the first time this relationship has been reported," Kaz said.

For more information:

• Ari J. Kaz, MD, can be reached at the Department of Orthopaedics, Indiana University Medical Center, 541 Clinical Drive, Suite 600, Indianapolis, IN 46202; 208-377-1000; e-mail: arijkaz@hotmail.com. He has no financial conflicts to disclose.
• Kaz AJ, Coughlin MJ. Crossover second toe: demographics, etiology and radiographic assessment. Presented at the American Orthopaedic Foot and Ankle Society 23rd Annual Summer Meeting. July 13-15, 2007. Toronto.