Overlapping Toes

DESCRIPTION
Overlapping toes are a relatively common forefoot problem. Most frequently, this problem seems to affect the second toe crossing over the big toe. Proper evaluation usually requires an x-ray to determine the extent of the deformity. These x-rays should be taken with the patient weight bearing, this is when the deformity is more pronounced.

CAUSE
While the cause of overlapping toe in not clearly understood. Bunions, trauma, inflammatory conditions, hereditary factors, and biomechanical issues have all been named as potential factors. Bunions are among the more common causes of an overlapping 2nd toe. As a bunion progresses, the big toe begins to migrate towards the little toes. This often causes the 2nd toe to overlap the big toe. High heeled or narrow-toed shoes may also lead to joint destabilization and result in an overlapping toe. For this reason, the condition seems to be more common in females.

SYMPTOMS
The condition tends to be progressive and should not be ignored. Overlapping toes can result in severe skin irritation and joint destruction. A painful callus may develop over the knuckle on top of the toe causing severe pain. Also, because the joint has deviated to the side, arthritis develops and pain occurs when the toe joint is moved. Diabetics should be extra cautious with overlapping toe as they often develop ulcerations on the toes secondary to pressure.

TREATMENT
Conservative treatment (non-surgical) of overlapping toes begins with accommodating the disorder. Patients are advised to wear shoes with a high, wider toe box. This will prevent the toe from rubbing against the shoe or neighboring toes. Additionally, padding, strapping, and taping are useful in realigning the toe. These techniques are designed to physically pull the toe back into anatomical position and reduce friction and relieve discomfort. It is important to note however, that techniques such as taping and splinting may alleviate the symptoms but will not correct the deformity. In longer standing or more severe cases, surgical treatment may be required. When surgery is indicated, the degree of the deformity determines the procedure. With a mild flexible deformity, a simple release of the tendon in the bottom of the toe will suffice. If the deformity is rigid in nature, the removal of a small portion of bone is the toe may be necessary.