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 bearing weight, this is when the deformity is more pronounced.
The causes of overlapping toes are not clearly understood, but bunions, foot trauma, inflammatory conditions, hereditary factors, and bio-mechanical issues are thought to be factors. An overlapping 2nd toe is most commonly found in patients with bunions. This relation comes from the progression of a bunion. As a bunion develops the big toe tends to migrate toward the little toes.
Like many other foot conditions, wearing high heeled or narrow-toed shoes can lead to destabilization of the joints in the foot resulting in overlapping toes. For this reason, overlapping toes seem to be more common in females.
The condition tends to be progressive and should not be ignored. Overlapping toes can result in severe skin irritation and joint destruction. A 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.
Conservative Treatment of Overlapping Toes
Conservative treatment (non-surgical) of overlapping toes begins with accommodating the disorder. By preventing the toe from rubbing against a worn shoe or against other toes, we can start to prevent overlapping toes. One way to do this is to wear shoes with a high, wide toe box. 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. Techniques such as splinting and taping toes may alleviate the symptoms but will not completely correct the deformity.
Surgery for Overlapping Toes
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.