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What is an Overlapping or Underlapping Toe?

An overlapping or underlapping toe is an abnormal condition in which a toe overlaps or underlaps the toe next to it. Although this can happen with any toe, it usually affects the fifth and second toes. The toe may be flexible, allowing it to return to its normal position, or it may be rigid and fixed. 

Causes of Overlapping or Underlapping Toe 

Overlapping or underlapping of the toe may be present from birth (congenital) or may develop later in life. Causes include:

  • Family history
  • Position of the fetus in the womb
  • Arthritis (joint inflammation and stiffness)
  • Toe and foot deformities such as bunions, hammertoes, unusually long toe or flatfeet
  • Imbalance in the toe muscles
  • Foot injuries
  • Tight footwear
  • An abnormal gait

Symptoms of Overlapping or Underlapping Toe

Other than its abnormal appearance, an overlapping or underlapping toe may not produce any symptoms. Young children who have not started walking usually don’t experience any symptoms. Symptoms that may appear later include:

  • Pressure and irritation of the toes
  • Difficulty walking due to pain and swelling of the toes
  • Formation of calluses and corns

Treatment for Overlapping or Underlapping Toe

As long as the overlapping or underlapping toe does not cause pain or affect your walking pattern, there is no need for treatment. These conditions do not usually improve on their own, however. If it becomes painful, treatment will be necessary and is based on whether the deformity is flexible or rigid. Treatment also depends on your age, symptoms and the extent of the deformity. Early treatment before a child starts to walk is more effective in correcting the deformity. Your doctor may recommend:

Conservative treatment for early or flexible overlapping or underlapping toes, including:

  • Proper-fitting shoes: Well-fitting shoes with a wide toe area
  • Toe spacers and separators: These help keep the toes in proper alignment by separating them from each other.
  • Toe-strapping: Also called splinting, this involves strapping the toe to its adjacent toe, which gradually promotes realignment.
  • Protectors for corns: This is a covering that protects the corn against rubbing, allowing it to heal.
  • Crest pad for hammertoe: This is a kind of gel or foam pad placed under the toe to help relieve the pressure causing a hammertoe.
  • Physical therapy: Physical therapy may be recommended to release the tight muscles and tendons that are responsible for the overlapping toes. 
  • Applying ice: Ice may be applied on the irritated regions of the toes to relieve symptoms.

Surgery is recommended when symptoms are severe and interfering with daily activities. Common procedures include:

  • Butler’s arthroplasty: The tendon from the foot to the fifth toe is cut and its length is increased so that the toe alignment is corrected.
  • DuVries arthroplasty: Here the ligament between the toes is released so that the pressure exerted on the overlapping toe is reduced, allowing gradual movement to a normal position. 

Choosing the Right Footwear to Prevent Toe Overlapping or Underlapping

Congenital defects cannot be avoided but can be prevented from getting worse. While choosing footwear, you can manage toe overlapping or underlapping in the following ways:

  • Purchase shoes or sandals for the end of the day when feet may be swollen
  • Try on the shoes before buying and ensure a roomy toe area
  • Avoid very tight or very lose shoes
  • Avoid shoes with pointed toes  
  • Make sure the shoe surface doesn’t rub against the overlapping toes or the bunions 
  • The Arthroscopy Association of North America
  • The American Osteopathic Academy of Orthopedics (AOAO)
  • The American Academy of Orthopaedic Surgeons
  • American Orthopaedic Foot & Ankle Society┬«
    Orthopaedic Foot & Ankle Foundation
  • American Academy of Osteopathy
  • American Osteopathic Association