Prevalence of Morton’s toe: a systematic review and meta-analysis [version 3; peer review: 2 approved]

Дата публикации: 24-06-2026 09:43:44

Background When the second toe is longer than the big toe, it is referred to as Morton’s toe. Although the occurrence of Morton’s toe is considered normal and seen across many populations, its prevalence and associated risks have not been sufficiently explored. Some studies reported a very high occurrence of Morton’s toe, whereas others reported it to be low. These differences in prevalence of Morton’s toe and lack of a standard dataset regarding the associated risks of Morton’s toe made us to perform a systematic review and meta-analysis on the prevalence of Morton’s toe. Methods A systematic literature search was performed in Google Scholar, MEDLINE, PubMed, SciELO, and ScienceDirect data bases using “Morton’s Toe” AND “Risks” AND “Prevalence,” search terms adopting PRISMA guidelines. Results Literature search yielded 935 article links, of which five studies met the inclusion criteria. These five studies comprised of 2636 feet, which were in the age range of 16–90 years. Our pooled analysis revealed that the prevalence of Morton’s toe was 40% and in different populations, it was ranging from 28–66%. Statistical heterogeneity among studies was extremely high, with a heterogeneity of I2 = 97.5%, τ2 = 0.0347 (p

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Systematic Review

Revised

[version 3; peer review: 2 approved]

Zainab Mohsen Hasan Habib¹, Abdulaziz Nawaf Al-Qaed

https://orcid.org/0009-0006-2213-276X

², Anas Abdulmenen Yahya³, [...] Mohamed Abdulla Al-Balushi⁴, Amer Almarabheh⁵, Wael Amin Nasr El-Din

https://orcid.org/0000-0003-3673-990X

⁶, Bhagath Kumar Potu

https://orcid.org/0000-0002-7945-5037

⁷

Zainab Mohsen Hasan Habib¹, Abdulaziz Nawaf Al-Qaed

https://orcid.org/0009-0006-2213-276X

², [...] Anas Abdulmenen Yahya³, Mohamed Abdulla Al-Balushi⁴, Amer Almarabheh⁵, Wael Amin Nasr El-Din

https://orcid.org/0000-0003-3673-990X

⁶, Bhagath Kumar Potu

https://orcid.org/0000-0002-7945-5037

⁷

Author details Author details

¹ College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain
² College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain
³ College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain
⁴ College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain
⁵ Department of Family and Community Medicine, College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain
⁶ Department of Anatomy, College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain
⁷ Department of Anatomy, College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain

Zainab Mohsen Hasan Habib
Roles: Data Curation, Investigation, Methodology

Abdulaziz Nawaf Al-Qaed
Roles: Data Curation, Investigation, Methodology

Anas Abdulmenen Yahya
Roles: Investigation

Mohamed Abdulla Al-Balushi
Roles: Investigation

Amer Almarabheh
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Software, Validation, Writing – Review & Editing

Wael Amin Nasr El-Din
Roles: Supervision, Writing – Review & Editing

Bhagath Kumar Potu
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

When the second toe is longer than the big toe, it is referred to as Morton’s toe. Although the occurrence of Morton’s toe is considered normal and seen across many populations, its prevalence and associated risks have not been sufficiently explored. Some studies reported a very high occurrence of Morton’s toe, whereas others reported it to be low. These differences in prevalence of Morton’s toe and lack of a standard dataset regarding the associated risks of Morton’s toe made us to perform a systematic review and meta-analysis on the prevalence of Morton’s toe.

Methods

A systematic literature search was performed in Google Scholar, MEDLINE, PubMed, SciELO, and ScienceDirect data bases using “Morton’s Toe” AND “Risks” AND “Prevalence,” search terms adopting PRISMA guidelines.

Results

Literature search yielded 935 article links, of which five studies met the inclusion criteria. These five studies comprised of 2636 feet, which were in the age range of 16–90 years. Our pooled analysis revealed that the prevalence of Morton’s toe was 40% and in different populations, it was ranging from 28–66%. Statistical heterogeneity among studies was extremely high, with a heterogeneity of I² = 97.5%, τ² = 0.0347 (p < 0.0001), indicating that most of the variability in prevalence estimates was due to real differences between studies rather than sampling error alone.

Conclusion

This study provides a comprehensive picture of the prevalence of Morton’s toe, which varies from population-to-population and is associated with certain risks such as overpronation (turning inward) of the foot, bunion deformity, hammertoe, and plantar fasciitis.

Open Science Framework (OSF) registration: https://doi.org/10.17605/OSF.IO/BGKY2.

Keywords

Morton’s toe; prevalence; associated risks; populations.

Corresponding author: Bhagath Kumar Potu Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2026 Habib ZMH et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Habib ZMH, Al-Qaed AN, Yahya AA et al. Prevalence of Morton’s toe: a systematic review and meta-analysis [version 3; peer review: 2 approved]. F1000Research 2026, 15:664 (https://doi.org/10.12688/f1000research.180137.3) First published: 04 May 2026, 15:664 (https://doi.org/10.12688/f1000research.180137.1) Latest published: 24 Jun 2026, 15:664 (https://doi.org/10.12688/f1000research.180137.3)

Revised Amendments from Version 2

We thank esteemed reviewers for their complements and valuable comments on our manuscript. We incorporated all the changes as suggested by the reviewers. All the changes made in revised manuscript are clearly stated and marked. We restructured some of the statements in the background section as suggested by the reviewer. Additionally, a brief note has been added on the embryological background of the congenital shortening of first metatarsal bone as suggested by potential reviewers. We incorporated the references (reference nos: 11-15) in the discussion column as suggested by the reviewers. We sincerely appreciate and thank reviewers for their meticulous and thorough review process.

See the authors' detailed response to the review by B.V. Murlimanju
See the authors' detailed response to the review by Muddanna S. Rao

Background

The foot usually consists of five toes, each having three phalanges, proximal, intermediate and distal, except the big toe, which is made up of only the proximal and distal phalanges.¹ Despite this, the big toe is usually longer than the length of second toe due to the fact that the first metatarsal bone is longer than the second metatarsal bone. This normal feature of the foot is very important for maintaining biomechanical support and balance while walking. In contrast, in some cases, the big toe could be shorter than the second toe, and when the second toe is longer than the big toe, it is called Morton’s toe (Figure 1). This structural anomaly was first observed by British anthropologist James Park Harrison in 1864 and was later described by the American orthopedic surgeon, Dudley Morton.²

Figure 1. Showing the long 2^nd toe (Morton’s toe).

Some studies even link Morton’s toe (also known as Greek toe, Royal toe) to individual’s genetics and to certain human races. The occurrence of Morton’s toe varies considerably across different populations. Some studies reported a high occurrence of Morton’s toe, while others reported a low-to-none occurrence.^3–7 These differences in prevalence are attributed to race, ethnicity, and the different assessment methods used to quantify the frequency of occurrence.^3–7 The lack of standard dataset on the true distribution of Morton’s toe and lack of consensus between different studies makes it an excellent research topic to explore. Moreover, studies which have investigated Morton’s toe reported many associated risks that can occur as a result of this structural variation.^4–6 This is primarily due to the alteration of the foot biomechanics, which results in an excess load being transferred onto the second toe instead of the big toe, leading to an imbalance in pressure distribution and unstable gait, which leads to the formation of calluses, hammertoe, metatarsalgia, bunion deformity, pronation of the foot, and plantar fasciitis.⁶ As there exists variability in reported prevalence and associated risks in different studies, an extensive review of available reports was conducted and analysed to gain a better understanding of Morton’s toe prevalence and associated risks.

Methods

Search strategy & inclusion-exclusion criteria

A thorough electronic literature search was conducted on Google Scholar, MEDLINE, PubMed, SciELO, and ScienceDirect data bases. The keywords used for the search were “Morton’s Toe” AND “Risks” AND “Prevalence.” To arrive at a standard dataset of this biomechanically important area, we strictly confined our search criteria to the original cross-sectional studies published in English and conducted among the young adolescent and adult population by excluding all case reports, case series, letters to the editor, brief communications, and studies that did not meet the keywords of our search. Two authors (BKP and AA) independently evaluated each included article, and any disagreements were discussed and addressed by other authors (ZMHH, WANE, ANA, AAY, and MAA). The mean pooled data on the prevalence of Morton’s toe was set as the outcome of our study. The references of the included studies were thoroughly checked and duplicates were removed. The titles and abstracts of the articles were initially screened to obtain full-text articles (Figure 2). The guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020)⁸ were used to collect our data.⁹ This study was conducted upon receiving ethical approval from the Research & Ethics Committee (REC) of the College of Medicine and Health Sciences, Arabian Gulf University (Reference no: E27-PI-02-26) and registered in the Open Science Framework (OSF) Registries (Registration: https://doi.org/10.17605/OSF.IO/BGKY2).

Figure 2. Application of selection criteria as per PRISMA guidelines.

Quality assessment

The quality of the studies included in the systematic review was assessed independently by two authors (BKP and AA). All studies included in this systematic review were cross-sectional studies. Therefore, the Newcastle-Ottawa Quality Assessment Scale was applied for quality assessment, as described by Wells et al.¹⁰ Using this scale, the risk bias was analyzed with a tool of three domains, that is, selection criteria, comparability criteria, and outcome/exposure criteria. Every eligible study of our systematic review was scored for each domain by giving a maximum of four stars for the selection criteria, and a maximum of two stars for the comparability criteria with a maximum of three stars for the outcome/exposure criteria.

Statistical analysis

A systematic review and meta-analysis were conducted to evaluate the prevalence of Morton’s toe. Statistical analysis was performed using R software (version 12.1). A random-effects meta-analysis of proportions was conducted using the meta package with the Freeman–Tukey transformation. Heterogeneity was quantitatively assessed using Cochran’s Q test, I² statistic, and tau-squared value (τ²). An I² value of >75% was considered indicative of high heterogeneity. Forest plots were generated to display the pooled prevalence with 95% confidence intervals. Statistical significance was set at p < 0.05. The study design and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to ensure methodological transparency and reproducibility.

Results

Studies included

Although 935 records were retrieved from the databases, a total of five studies including 2636 feet with a sample of 1298 male, 1228 female and 110 unspecified feet met the study criteria ( Table 1 and Figure 3). Although 935 records were retrieved from the databases, only 5 studies (n = 5; 0.53% of studies) were included in our analyses because most of the studies did not report the data on keywords used in our study. The specimens included in these studies were in a range of 16–90 years age. Four studies^3,5–7 reported sex distribution in 1298 male and 1228 female lower limbs. One study⁴ did not specify the sex of the feet. ( Tables 1, 2, 3, 4, and 5 show the characteristics of the included studies, outcomes, and quality assessment of individual studies using the appropriate Newcastle-Ottawa Scale).

Table 1. Studies included in our search.

Serial number AuthorCountryYear Study designProcedure 1Aigbogun et al.³Nigeria2019Cross-sectional Random selection, Physical observation 2Marinova et al.⁴Bulgaria2022Cross-sectional Random selection, Plantograms 3Paul et al.⁵Nigeria2023Cross-sectional Random selection, Questionnaire, Physical observation 4Potu et al.⁶Bahrain2023Cross-sectional Random selection, Physical observation 5Paul et al.⁷Nigeria2024Cross-sectional Random selection, Questionnaire, Physical observation

Figure 3. Forest plot of overall prevalence of Morton’s toe using “Random-Effects” model.

CI: confidence intervals, τ² = tau-squared.

Table 2. Characteristics of the included studies.

Serial numberAuthorSample sizeSexAge range 1Aigbogun et al.³674338-Male; 336-FemaleNR 2Marinova et al.⁴102NR18–60 3Paul et al.⁵768426-Male; 334-Female18–77 4Potu et al.⁶200100-Male; 100-Female17–75 5Paul et al.⁷892434-Male; 458-Female16–90

Table 3. Prevalence of Morton’s toe and associated risks.

Serial number AuthorCountryYearPrevalence of Morton’s toeAssociated risks 1Aigbogun et al.³Nigeria201935.3%NR 2Marinova et al.⁴Bulgaria202245%Elevated medial longitudinal arch of the foot 3Paul et al.⁵Nigeria202328.3%NR 4Potu et al.⁶Bahrain202328%Hammertoe, metatarsalgia, bunion deformity, overpronation of the foot and plantar fasciitis 5Paul et al.⁷Nigeria202465.9%NR

Table 4. Gender-wise prevalence of Morton’s toe.

Serial numberAuthorCountryYearPrevalence of Morton’s toe MaleFemale 1Aigbogun et al.³Nigeria201919%16.3%2Marinova et al.⁴Bulgaria2022NRNR 3Paul et al.⁵Nigeria202318.7%9.4%4Potu et al.⁶Bahrain20239%19%5Paul et al.⁷Nigeria202434.7%31.2%

Table 5. Quality assessment of the studies based on Newcastle-Ottawa scale.

Study referenceSelection criteria¹ Comparability criteria² Exposure/Outcome criteria³ Aigbogun et al.³ (2019)********Marinova et al.⁴ (2022)********Paul et al.⁵ (2023)*******Potu et al.⁶ (2023)*********Paul et al.⁷ (2024)*******

Prevalence of Morton’s toe

Five studies reported the prevalence of Morton’s toe in different populations ( Table 3 and Figure 3). Our pooled analysis revealed that the prevalence of Morton’s toe was 40% from different populations studied. The samples from Nigeria^3,5,7 revealed prevalence of the Morton’s toe ranging from 28.3% to 65.9% with Bulgaria sample⁴ revealing 45% prevalence and a least being 28% from Bahraini population.⁶ Pooled analysis on the gender-wise prevalence of Morton’s toe from five studies revealed 20.35% in males and 18.97% in females with no statistically significant differences. A sample from Nigeria^3,5,7 revealed a higher prevalence of Morton’s toe in males than the females. However, the sample from the Bahraini population⁶ revealed a higher prevalence of Morton’s toe in females than in males ( Table 4 and Figure 4).

Figure 4. Forest plot of gender-wise prevalence of Morton’s toe using “Random-Effects” model.

CI: confidence intervals, τ² = tau-squared.

Morton’s toe and the associated risks

Of the five studies, three from the Nigerian population^3,5,7 did not report any data on the associated risks of Morton’s toe ( Table 3). Two studies have reported the associated risks.^4,6 Study from Bulgaria⁴ reported that Morton’s toe is associated with elevated medial longitudinal arch of the foot, and another study from Bahrain reported multiple risks associated with Morton’s toe.⁶ These associated multiple risks were being hammertoe, foot overpronation, bunion deformity, and plantar fasciitis.⁶

A meta-analysis using a random-effects model demonstrated an overall pooled prevalence of approximately 40%, indicating that Morton’s toe is relatively common in the studied population. The pooled 95% confidence interval ranged from approximately 28% to 66%, reflecting variability across studies. The forest plot visually demonstrated the distribution of study-specific prevalence estimates and their confidence intervals. While several studies clustered around the pooled estimate, one study⁷ showed a notably higher prevalence, which likely contributed to the wide pooled confidence interval and overall heterogeneity. Statistical heterogeneity among studies was extremely high, with an I² value of approximately 97.5%, indicating that most of the variability in prevalence estimates was due to real differences between studies rather than sampling error alone. The meta-analysis using a random-effects model demonstrated gender-wise pooled prevalence, as depicted in Figure 4. The significant heterogeneity may be explained by differences in geographic populations, study design, sample size, measurement techniques, and demographic characteristics of the participants.

Discussion

The current study provides a comprehensive dataset on the prevalence of Morton’s toe in various populations, ranging from 28% to 66%.^3–7 The prevalence of Morton’s toe in this study was 40% (95% CI: 22,60), with a heterogeneity of I² = 97.5%, τ² = 0.0347 (p < 0.0001). Morton’s toe, which occurs due to congenital shortening of the first metatarsal bone resulting from the premature closure of the epiphyseal plate in the first metatarsal bone, could vary from population to population, as observed in our study. This congenital shortening of first metatarsal bone is known as brachymetatarsia, a condition which typically affects the fourth metatarsal, followed by the first metatarsal bone.¹¹ Among all the studies analyzed in our review, the sample from Nigerian populations reported that Morton’s toe could be genetically inherited, suggesting a complex inheritance pattern that does not follow simple Mendelian models, further supporting the multifactorial nature of Morton’s toe.^3,5,7,12,13 Taken together, these findings indicate that Morton’s toe likely arises from an interplay of anatomical, lifestyle, and genetic factors, emphasizing the need for a comprehensive perspective when studying or managing this condition. However, our study did not include any search for patterns of genetic inheritance.

Although Morton’s toe is considered to be a normal anatomical variant, a recent study conducted on 214 patients revealed a few cases reporting that it could lead to gait disturbances and this in turn disturbs the distribution of bodyweight causing neck pain, back pain, hip pain, knee pain and onychocryptosis, respectively.¹⁴^–¹⁶ Our previous findings clearly demonstrated that there was a statistically significant association between Morton’s toe and hammertoe (p = 0.044) and bunion deformity (χ2 = 4.069, df = 1, p < 0.001) with no statistically significant association between Morton’s toe and overpronation of foot (χ2 = 2.584, df = 1, p = 0.108); and plantar fasciitis (χ2 = 1.644, df = 1, p = 0.200).⁶ In addition to our findings, a study from Bulgarian population showed a significant association between the high arched foot and Morton’s toe (p < 0.05).⁴ It is important to understand how the individuals with Morton’s toe are more likely to develop associated risks such as plantar fasciitis, hammertoe and bunion deformity. Individuals with Morton’s toe overpronate their feet inward when they run or walk, which could increase the distance between the calcaneus and toes. Furthermore, this is associated with greater tension on the plantar fascia leading to plantar fasciitis and myofascial pain syndrome.^6,16 In cases of hammertoe, when inward curling of big toe occurs, the pressure and frictional force exerted on the skin and soft tissue of the first metatarsophalangeal joint. Over time, this can lead to callus formation and stress fractures. Although it is thought to be secondary to hereditary and environmental factors, a higher incidence of bunion deformity resulting from Morton’s toe is seen more in women than in men, which is believed to be due to tightly fitting women’s footwear.¹⁷

Our analysis from previously published studies^6,7 also suggests that the occurrence of Morton’s toe is more commonly seen in the age group of 30–45 years, particularly in females. However, our pooled analysis of the gender-wise occurrence of Morton’s toe did not reveal any significant statistical differences. Studies reported that the Morton’s neuroma resulting from anatomical variations such as Morton’s toe could be seen more in females at least five times more than males,¹⁸ that to in middle-aged individuals particularly those wearing narrow and high-heeled footwear.^19,20 Reported cases of Morton’s toe and Morton’s neuroma are often associated with pain exacerbated by walking with tight or heeled shoes and such pain seems to be improved by resting or wearing the appropriate footwear and Morton’s extension.^17,21–23 Morton’s extension available in the form of a flexible pad is known to raise the first metatarsal head. When the first metatarsal head is raised, the length of the great toe increases, which further increases the medial longitudinal arch. Such biomechanical changes resulting from wearing Morton’s extension pad are known to alleviate pain resulting from Morton’s toe by reducing the higher pressure on the second metatarsal.²³ It has been reported that increased pressure on the second metatarsal results in mid-foot arthrosis.²⁴

In conclusion, for the first time, our findings provide a standard dataset on the prevalence of Morton’s toe in this systematic review and meta-analysis that has been conducted. Our findings discussed and revealed a significant association between Morton’s toe and certain risks. The results suggested that Morton’s toe prevalence varied from 28% to 66%. Despite its high prevalence, many people are unaware of Morton’s toe and its associated risks. Therefore, it is essential to raise awareness of Morton’s toe and take preventive measures for associated risks.

References

1. Agur AM, Dailey AF: Moore’s essential anatomy. Baltimore: Lippincott Williams & Wilkins; 3rd ed.2006.
2. Morton DJ: Metatarsus atavicus: the identification of a distinct type of foot disorder. J. Bone Joint Surg. 1927; 9: 531–544.
3. Aigbogun EO, Alabi AS, Didia BC, et al.:Morton’s Toe: prevalence and inheritance pattern among Nigerians.Int. J. Appl. Basic Med. Res.2019; 9(2): 89–94. PubMed Abstract | Publisher Full Text | Free Full Text
4. Marinova D, Angelova M, Zhekova V:Morton’s toe frequency among the Bulgarian population and its association with high arched foot.Acta Morphol. Anthropol.2022; 29(1–2): 124–129. Publisher Full Text
5. Paul JN, Ochai J, Madume AK, et al.:Prevalence of Morton’s toe among the Idoma tribe, Benue state, Nigeria.Sch. J. App. Med. Sci.2023; 11(3): 506–510. Publisher Full Text
6. Potu BK, Saleem BMM, Al-Shenawi N, et al.:Prevalence of Morton’s toe and assessment of the associated risk factors: a cross-sectional study.Eur. J. Anat.2023; 27(6): 717–722. Publisher Full Text
7. Paul JN, Edet IE, Briggs LI, et al.:Prevalence of Morton’s toe amongst people of the Kalabari tribe, Rivers State, Nigeria.Saudi J. Biomed. Res.2024; 10(3): 90–94. Publisher Full Text
8. Page MJ, McKenzie JE, Bossuyt PM, et al.: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71. PubMed Abstract | Publisher Full Text | Free Full Text
9. Potu BK: PRISMA Checklist- Prevalence of Morton’s toe: a systematic review and meta-analysis. Dataset. figshare. 2026. Publisher Full Text
10. Wells GA, Shea B, O’Connell D, et al.: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. (accessed on 5 April 2026). Reference Source
11. Córdoba-Fernández A, Vera-Gómez ML: Literature Review on Brachymetatarsia. Orthop. Nurs. 2018; 37(5): 292–302. PubMed Abstract | Publisher Full Text
12. Harrison MA: An exploratory study of the relationship between second toe length and androgen-linked behaviors. J. Soc. Evol. Cult. Psychol. 2010; 4(4): 241–253. Publisher Full Text
13. Lautzenheiser SG, Kramer PA: Linear and angular measurements of the foot of modern humans: a test of Morton’s foot types. Anat. Rec (Hoboken). 2013; 296(10): 1526–1533. PubMed Abstract | Publisher Full Text
14. Sharma D, Agarwal P, Singh M: Determination of Types of Foot in the Indian Population and Its Association with Ingrowing Toenail. J. Foot Ankle Surg. 2018; 5(1): 13–15. Publisher Full Text
15. Pita-Fernandez S, González-Martín C, Seoane-Pillado T, et al.: Podiatric medical abnormalities in a random population sample 40 years or older in Spain. J. Am. Podiatr. Med. Assoc. 2014; 104(6): 574–582. Publisher Full Text
16. Hartz R, Biancalana M: Re-examining Morton’s toe as a pain disorder. Pract. Pain Manag. 2022; 22(2).
17. Ayub A, Yale SH, Bibbo C: Common foot disorders. Clin. Med. Res. 2005; 3(2): 116–119. PubMed Abstract | Publisher Full Text | Free Full Text
18. Santiago FR, Muñoz PT, Pryest P, et al.: Role of imaging methods in diagnosis and treatment of Morton’s neuroma. World J. Radiol. 2018; 10(9): 91–99. Publisher Full Text
19. Del Mar Ruiz-Herrera M, Criado-Álvarez JJ, Suarez-Ortiz M, et al.: Study of the Anatomical Association between Morton’s Neuroma and the Space Inferior to the Deep Transverse Metatarsal Ligament Using Ultrasound. Diagnostics (Basel). 2022; 12(6): 1367. Publisher Full Text
20. Galley J, Sutter R, Germann C, et al.: The Vulcan salute sign: a non-sensitive but specific sign for Morton’s neuroma on radiographs. Skeletal Radiol. 2022; 51(3): 581–586. PubMed Abstract | Publisher Full Text | Free Full Text
21. Mahadevan D, Venkatesan M, Bhatt R, et al.: Diagnostic Accuracy of Clinical Tests for Morton’s Neuroma Compared With Ultrasonography. J. Foot Ankle Surg. 2015; 54(4): 549–553. Publisher Full Text
22. Ganguly A, Warner J, Aniq H: Central Metatarsalgia and Walking on Pebbles: Beyond Morton Neuroma. Am. J. Roentgenol. 2018; 210(4): 821–833. PubMed Abstract | Publisher Full Text
23. Sivaji AR, Kizhakkemuriyil Scaria T, Sundaramurthi I: Morton’s Foot Syndrome: A Case Report and Overview. Cureus. 2024; 16(9): e68731. Publisher Full Text
24. Davitt JS, Kadel N, Sangeorzan BJ, et al.: An association between functional second metatarsal length and midfoot arthrosis. J. Bone Joint Surg. Am. 2005; 87(4): 795–800. PubMed Abstract | Publisher Full Text

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Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (3)

Published: 24 Jun 2026, 15:664

Published: 22 May 2026, 15:664

Published: 04 May 2026, 15:664

© 2026 Habib ZMH et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Open Peer Review

Current Reviewer Status: ?

Key to Reviewer Statuses VIEW HIDE

ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions

Version 2

VERSION 2

PUBLISHED 22 May 2026

Revised

Reviewer Report 15 Jun 2026

Muddanna S. Rao, Department of Anatomy, College of Medicine, Kuwait University, Jabriya, Kuwait, Kuwait

Approved

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Yes
Are the conclusions drawn adequately supported by the results presented in the review?

Yes
If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.)

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Anatomy, Neuroscience

Reviewer Report 15 Jun 2026

B.V. Murlimanju, Kasturba Medical College , Manipal Academy of Higher Education, Mangalore, India

Approved

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Yes
Are sufficient details of the methods and analysis provided to allow replication by others?

Yes
Is the statistical analysis and its interpretation appropriate?

Yes
Are the conclusions drawn adequately supported by the results presented in the review?

Yes
If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.)

Yes

References

1. Sivaji A, Kizhakkemuriyil Scaria T, Sundaramurthi I: Morton’s Foot Syndrome: A Case Report and Overview. Cureus. 2024. Publisher Full Text
2. Lautzenheiser S, Kramer P: Linear and Angular Measurements of the Foot of Modern Humans: A Test of Morton'S Foot Types. The Anatomical Record. 2013; 296 (10): 1526-1533 Publisher Full Text
3. Harrison M: An exploratory study of the relationship between second toe length and androgen-linked behaviors.Journal of Social, Evolutionary, and Cultural Psychology. 2010; 4 (4): 241-253 Publisher Full Text
4. Sharma D, Agarwal P, Singh M: Determination of Types of Foot in the Indian Population and Its Association with Ingrowing Toenail. Journal of Foot and Ankle Surgery (Asia Pacific). 2018; 5 (1): 13-15 Publisher Full Text
5. Pita-Fernandez S, González-Martín C, Seoane-Pillado T, Pertega-Diaz S, et al.: Podiatric Medical Abnormalities in a Random Population Sample 40 Years or Older in Spain. Journal of the American Podiatric Medical Association. 2014; 104 (6): 574-582 Publisher Full Text
6. Ives Chatain, Elizabeth Peña T., Didier Rodríguez: Estudio anatomo-clínico de los morfotipos digitales del antepié colombiano. Colombia Medica. 1986; 17 (2): 85-90 Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: My area of interest in the research include Developmental anatomy of the menisci of knee joint, Neurosciences animal model research on Alzhheimer's diseases, clinical anatomy of the muscles, Morphology and Anthropology of human musculoskeletal system.

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Open Peer Review

Reviewer Status

Alongside their report, reviewers assign a status to the article:

Approved: The paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations: A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved: Fundamental flaws in the paper seriously undermine the findings and conclusions

Reviewer Reports

	Invited Reviewers
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Version 1 04 May 26

B.V. Murlimanju, Kasturba Medical College , Manipal Academy of Higher Education, Mangalore, India
Muddanna S. Rao, Kuwait University, Jabriya, Kuwait

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Prevalence of Morton’s toe: a systematic review and meta-analysis [version 3; peer review: 2 approved]

Дата публикации: 24-06-2026 09:43:44

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Abstract

Background

Methods

Results

Conclusion

Keywords

Revised Amendments from Version 2

Background

Figure 1. Showing the long 2nd toe (Morton’s toe).

Methods

Search strategy & inclusion-exclusion criteria

Figure 2. Application of selection criteria as per PRISMA guidelines.

Quality assessment

Statistical analysis

Results

Studies included

Table 1. Studies included in our search.

Figure 3. Forest plot of overall prevalence of Morton’s toe using “Random-Effects” model.

Table 2. Characteristics of the included studies.

Table 3. Prevalence of Morton’s toe and associated risks.

Table 4. Gender-wise prevalence of Morton’s toe.

Table 5. Quality assessment of the studies based on Newcastle-Ottawa scale.

Prevalence of Morton’s toe

Figure 4. Forest plot of gender-wise prevalence of Morton’s toe using “Random-Effects” model.

Morton’s toe and the associated risks

Discussion

References

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Open Peer Review

Reviewer Status

Reviewer Reports

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Figure 1. Showing the long 2^nd toe (Morton’s toe).