Underlapping and Overlapping Toes

 Toe deformities are quite common. They can result in the toes curling under other toes or over them. They can happen in both kids and adults. We inherit our foot type from our parents/grandparents, and generally the foot type that is inherited can cause the underlapping or overlapping of toes. Sometimes shoes or trauma to the toe can cause the toe to underlap or overlap as well. They can get worse over time if no treatment is provided. In the pediatric population, they rarely complain of pain or side effects of the underlapping or overlapping toes. The parents will usually complain about the cosmetic appearance of the toe.

The most commonly involved toes are the fourth and fifth toes in underlapping toes and the fifth and second toe for overlapping toes. Typically, the condition occurs in both feet, but can also happen in one foot. Clinodactyly is the medical term for congenital curly toes. No one knows exactly why this condition can occur from birth. Again, it may be inherited from parents/grandparents, or certain types of shoes may cause it to form over time. The fetus position in the womb may also cause this to happen. When there is an imbalance in the muscles and tendons in the foot, it can cause the toe to contract and curl over. When this happens, calluses/corns may form over protruding areas or areas that rub on the other toes.

Treatment for underlapping and overlapping toes depends on the patients age and pain level. Imaging, such as x­rays, will be taken to see the exact structure of the bone. Typically, if the deformity does not cause any pain, then no treatment is necessary. Strapping can be used to help bring the toe over while the baby’s tissues are still forming. Strapping generally requires 6­12 weeks of doing so and the condition may also come back, either immediately or later in life.

Strapping, in some cases, may work in adults as well, but not typically. If the symptoms are mild then they typically can be treated conservatively with padding splints, and creams, depending on the symptom. The use of orthotics can help prevent the toes from getting worse and can take pressure off the areas that are causing pain.

If there is intense pain and the toe is still flexible, generally a soft tissue procedure can help straighten the toe out. This may be performed in your doctors office or in a surgery center and the recovery is not as long as a boney procedure. If the condition is rigid, and the toe has fused and is unable to be straightened simply by pulling on the toe, then the toe requires cutting the bone to realign it. Hardware may be placed, either temporarily or permanently, to help keep the toe straight. This hammertoe procedure can be done in office or outpatient surgery center and the recovery depends on the exact type of procedure done and if any hardware is put in. In some cases, a skin plasty may be done to help straighten the rotated toe as well.

If you are suffering from overlapping or underlapping toes, make sure you have your feet evaluated by a podiatrist. It is never too early to be evaluated by your podiatrist, so if you notice your children having irregular feet or toes make sure you bring them in as soon as possible for an evaluation before the condition gets worse. Here at Advanced Podiatry, we see a range of ages, from newborns and infants, to adults and geriatrics. Don’t suffer with foot pain, call us today at (813)­ 875-­0555.

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