Lower back pain and left 2nd toe overlapping the hallux. This was causing pain in the second MTP joint and she was having a hard time finding a pair of shoes that she could even place her foot into without it pressing on her second toe.

She was wondering if surgery would be the route to remove the second toe.  I suggested exhausting all conservative treatment first before completing an invasive treatment.

Non-weight bearing

Full range of motion in bilateral subtalar joint and ankle joint
Full range of motion in bilateral MTP joints
Overlapping second toe on the left foot
Severe bunion on left foot

Weight bearing

Moderately pronated midfoot on right and severly pronated on left
Rearfoot valgus
Slight genu valgum
Functional leg length discrepancy left < right by 6mm

Gait Analysis

Lateral heel strike during initial contact
Moderate pronation during midstance with failure to toe off
Limp in gait dropping down on the left side

A treatment plan was designed to accomodate the left 2nd overlapping toe and bunion.  A pair of custom made foot orthotics were fabricated to correct the arch of both feet which allowed for the left side to be placed in it’s subtalar neutral position which then leveled out the hips. A pair of walking shoes were recommended to allow for adequate room in the toe box for the second toe on the left.

Although Peggy is still experiencing her second toe on her left foot still hitting the top of the toe box on occasion, the treatment has calmed down her lower back pain and shoe fitting problem.