Overlapping or Underlapping Toes
Overlapping toes are characterized by one toe lying on top of an adjacent toe. The most common overlapping toes are the second toe over the big toe and the fifth toe over the fourth toe. An overlapping fifth toe is often present at birth. Passive stretching and adhesive taping are commonly used to correct overlapping toes in infants, but the deformity usually recurs. Sometimes, if an overlapping fifth toe needs surgery, and is addressed earlier in life when the tissues are flexible, it can be corrected by releasing a tendon and soft tissues, without bone involvement. An overlapping second toe usually develops later in life and is part of a complex deformity that will usually require surgery and some internal fixation device. In the early stages of an overlapping second toe, it is often referred to as a pre-dislocation syndrome. At this early stage, usually, the pain is not in the toe, but rather on the bottom, in the ball of the foot, at the base of the second toe. Conservative treatment, with taping and orthotic devices, initiated early before significant deformity has taken place, will often slow progression and relieve discomfort. Visually, pre-dislocation syndrome initially reveals itself as an increased space between the second and third toes, and the second toe leaning on the great toe.
Underlapping toes usually involve the fourth and fifth toes. The cause of underlapping toes is speculated to be an imbalance in muscle strength of the small muscles of the foot. If deformed toes are flexible, a simple release of the tendon in the bottom of the toe will allow for them to straighten. If the deformity is rigid, surgery involving a reshaping of a bone will be needed.