According to the Injury classification system, metatarsal head deformity with no other associated conditions, is considered Level 1 Injury, as per the main dysfunction being found at the first Alignment protective layer.

This condition may cause significant pain at the bottom of the foot impairing the foot paddle action and when left untreated it may develop further into Turf toe or Hammer toe which is the most common toe related syndromes.

Another associated toe condition that usually follow a metatarsal head misalignment is Plantar warts. This viral disorder tends to be predisposed when the natural PH is decreased by the presence of chronic inflammation at the bottom of the foot compromising the local immune cells and predisposing for the appearance of this infection.

Associated Toe/Foot condition

Morton’s Neuroma is a common foot neurological disorder caused by a compromised transverse and lateral arches resulting the 3rd and 4th metatarsal head to misaligned irritating the nerve running along between the toes.

Ingrown toenail generally occurs due to improper cutting of the toenail at the sides. Best treatment is to cut the nail straight across with a ‘’V’’ cut in the middle of the top of the nail as will grow the nail out faster and will converge to the midline while growing out past the sides.


Mechanism of Dysfunction

The main predisposing factor for the development of toe abnormalities is the impaired foot and ankle mechanics caused by a compromised of the arches (see Flat foot page for detailed information)  therefore allowing the weight bearing stress to migrate further down the foot (base of the toes)  altering pedal action forces resulting in a dropped metatarsal head.


Assessment Protocol

The entire lower extremity biomechanical chain must be evaluated as part of the foot/Toe analyses as per the neurological and mechanical influences of the spine, hip, and knee.

Clinical assessment of the state of the all three arches, identifying the key joint dysfunctions of the Ankle/Foot that common involved in these toe conditions.

There are two specific tests that are used to identify dropped metatarsal head, Metatarsal Sulcus sing and Metatarsal head challenge test.


X-ray analysis.

Depending on the level of arch compromised, X-rays may be indicated to allow proper alignment analysis of the key joints.

Anterior – Posterior (AP) X-ray ankle view is essential for proper diagnosing the master joint of the ankle (Tibia-Talus) as the origin of poor arch mechanics starts from a dysfunctional ankle joint leading to hypermobility compensations that causes  the appearance of the toes abnormalities.

Lateral Xray view is important to check the degree of the total arch compromised as per the influence it has with the toe mechanics.

AP Xray foot view, aids to complete the total analysis of the transverse and lateral arches particular important in cases of morton’s neuroma.


Treatment protocol

Due to the influences the foot arches have in the development of toe deformities, arch rehabilitation must be incorporated as part of the overall treatment.

Foot Arch treatment: Specific adjustments of key bones of the ankle and foot (Talus, Navicular, Calcaneus and Cuboid) followed by a rehabilitation regime to strengthen the entire soft tissue arch support of the foot. In addition, application of tape and corrective orthotics may be needed as part of the early rehab program.

There are three direct important misalignments that needs to be addressed to aid on the reversion of toe deformities.

1 – Metatarsophalangeal head adjustment

2 – Interphalangeal adjustment

3 – Interphalangeal rotational adjustment

In a presence of Morton’s neuroma, Low level laser therapy and Therapeutic essential oils are added in the treatment protocol.

Depending on the level of arch compromised and chronicity of the toe deformity a minimum of 6 weeks up to 12 weeks of treatment care may be necessary to resolve this deformity.