So this is what happens when you don’t wear the right shoes as a kid… This woman came into the office with lower back pain. Do you notice anything peculiar about her feet? She said that when she was young she was told by the doctor she was “dink toed” and given special shoes (on a sidenote, she has bilateral external tibial torsion and no evidence of forefoot adductus) . The shoes evidently (according to the doctor) were too tight and caused the deformity that you see here. She stated that the shoes were extremely painful while wearing them and then for quite a while when she stopped. This is always been her “problem foot“ with limited toe dorsiflexion and ankle dorsiflexion on that side. Notice how the distal phalanx of the Halex is stunted and it’s with is increased. Dorsiflexion at the MTP is limited with respect to the other side and dorsiflexion flexion at the IP is limited as well. It appears that the growth plate was damaged resulting in a hypo plastic digit which, due to insufficient length, transfers a lot of weight during terminal stance and preceding ( at the end of her gait cycle, preparing for propulsion) to the second metatarsal head where she gets moderate discomfort. We can increase the motion of the first ray with mobilization and exercise but unfortunately we are not able to lengthen her digit. Growth plates are fragile things and what we do to children early on can have a profound impact upon their adult life. footproblem #toeproblem #hallux #halluxdeformity #bigtoe #gait #gaitanalysis #footexam