Overlapping and Underlapping Toes

While the direct cause of overlapping and underlapping toes has yet to be determined, there are many ways to treat this condition. This tendency for the toes to be forced above or beneath one another is often attributed to hereditary foot structures, crowding issues for babies while in the womb, and aggravation due to improper footwear.  While these conditions appear similar, there are subtle differences in the diagnoses of overlapping and underlapping toes.

Overlapping Toes

The excessive pressures of improper footwear and activity are often enough to trigger painful deformities in the joints of the toes.  While this condition can appear in any of the toes, it most commonly occurs in the second and fifth toes.  It is generally detected in the children of parents who also had overlapping toes.  While this deformity may look odd, it is often devoid of symptoms and most children are unaffected by its existence.  If action is not taken before the child matures, then the deformity may become rigid and require more intensive care.

Underlapping Toes

This foot condition is commonly seen in adults as well as children.  The most affected phalanges are the fourth and fifth toes.  They are thought to be forced beneath the other digits by slight imbalances in the strength and tension of tissues and joints within the feet.  The ligaments can pull on the toes, causing them to curl.  This unnatural curling of the toes is then progressed through weight-bearing and the use of improper footwear.

Conservative Treatments

The obtuse angle in which the toes sit can lead to the slow breakdown of skin tissue and open the way for bacterial infections.  When attempting to reduce the symptoms of overlapping toes, the first step is providing the condition with adequate space to relieve pressure.  This can be done by buying shoes with a large toe box.  The shoe needs to be deep as well as wide; overlapping toes generally protrude above the natural profile of the foot and require more vertical space.  In many cases, toecaps, combs and straighteners can be used to realign the toes without pain. Drs. Amy Miller-Guhl and David Guhl can also recommend specific exercises that can be used for treatment.

Surgical Procedures

In many cases surgery is required to permanently correct this condition.  While the toes can often be taped or held into position with toe straighteners, they commonly revert to their original position without surgical intervention.  Overlapping and underlapping toe surgeries have been very effective in correcting this condition.  The surgery necessary will depend on the patient’s age, lifestyle, and medical history.  Since this deformity is rather pliable in children, it can often be corrected by releasing the tension of the tissues around the joint.  In more extreme cases, a pin may be inserted to hold the toe into position while the toe heals.  When the condition has become rigid, a portion of the bone may need to be removed to allow the toes to properly realign with the foot.  Recovery can take up to six weeks following this surgery.  During this time, patients will need to stay off of the foot as much as possible and may need to wear a specific post-op shoe or removable cast.

As these conditions are rarely solved without surgery, it is always better to contact a professional as soon as possible to prevent future pain and irritation.  Schedule an appointment online or call our Waukesha office at (262) 544-0700 to meet with Drs. Amy Miller-Guhl and David Guhl.

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