Overlapping Toes

Overlapping toes are a common deformity of the toes in which one toe lies on top of the adjacent toe. It can occur at any age and can involve any toe, but is mostly seen in the fifth and the second toes.

Cause:

The exact cause of overlapping toes is still unclear, but a number of factors are considered responsible for overlapping toes.

• Genetics, as the condition runs in families.
• Position of the fetus during development inside the womb may affect the position of toes
• High arches or flat feet (fallen arches) in children alter the normal biomechanics of the foot, leading to overlapped toes, mostly the fifth toe.
• Hammer toes (toes bent in the form of a hammer) can also lead to overlapping of toes.
• Bunions cause the big toe to bend outwards towards the smaller toes, cramping their space and causing them to overlap. Usually the second toe overlaps.
• Ill-fitting shoes: high heels with narrow toe sections cause cramping of the toes. Prolonged cramping may lead to overlapping of the toes.
• Long second toe
• Injuries, dislocated joints may also be a reason for the overlapping of the toes.

Symptoms:

• It mostly involves the fifth or the second toe; however, any toe/toes can be involved.
• Usually toes on both feet overlap.
• The condition itself is asymptomatic, but the odd position of the toes present difficulty during walking in shoes. The overlapped toes rub against the inside of the shoe, leading to pain and inflammation.
• Constant friction against the shoe surface leads to the formation of corns (hardened skin) on the upper surface of the toes or in between the toes.
• Overlapping of the fifth (smallest) toe may lead to the formation of a small bump or bunionette on the outer side of the small toe joint, also called Tailor’s bunion.

If left untreated, the overlapping toes become fixed or rigid in the position, which are more difficult to realign.

Treatment:

Unlike many other foot deformities in children, overlapping toes do not often correct by themselves. It is better to seek treatment in the early stages, when conservative measures quite effectively remove the problem.

In infants, the toes are usually flexible and respond well to stretching exercises and tapping to hold the toes in a straight position. About two to three months treatment is required, but the toes may go back to the overlapped position afterwards.

In older children and adults, the treatment includes:

Making the toes comfortable by:

• Wearing shoes with wide toe sections to give the toes more space
• Avoiding high heels
• Using gel caps to cover and protect the corns and prevent friction and pain

Aligning the overlapping toes with the help of :

• Gel toe straighteners
• Gel toe stretchers
• Toe separators

These keep the toes stretched and separated, thus helping to realign them in their normal position.

Surgery should only be considered when the problem is severe and/or does not respond to conservative measures.

Surgical treatment involves releasing tension in the skin, tendons and surrounding soft tissues to remove the contracture and to straighten out the toe.

A pin may also be placed to keep the toe straight. This pin projects out from the toe and is removed two or three weeks after the operation. Meanwhile the foot is protected by applying a cast or special post-op shoe.