Overlapping Toes




What Are Overlapping Toes?

You may have long believed that your overlapping toe condition is merely cosmetic and not in need of correction, but having overlapping toes is actually a serious problem. It may not seem so when it first occurs, but if left untreated, this form of hammertoe can lead to discomfort and severe irritation, mostly due to the friction caused by toes not being in correct alignment with each other and with the interior surface of a shoe.

overlapping toes pictureOverlapping toe is most commonly seen with the fifth or "pinky" toe, which gets smashed up against the other toes over time until it almost seems to "overlap" them. In extreme cases the overlap can be more literal. The first toe, also known as the "big toe" is another common candidate to suffer from overlapping toe. Do not let these generalizations mislead you, however. The condition of overlapping toe can actually occur to any of the toes on the foot.

What Can Cause Me to Have Overlapping Toes?

Just as the condition is more serious than many people realize, so are the causes more complex. Common wisdom, as we all know, is often wrong. It certainly is so in this case, when common wisdom insists that the cause of overlapping toes is poor footwear, usually flawed because it is too cramped.

While it is true that overly tight footwear can exacerbate and worsen the condition of overlapping toes, it is not the only or even the primary cause of this physical condition in most people who suffer it. The root cause of overlapping toes is actually a hammertoe. So then, what is the cause of a hammertoe?

In essence, a hammertoe results from an imbalance between the muscles and tendons of the foot. This imbalance causes the foot to not function as it should, and over time this can lead to the development of a hammertoe, which is turn can develop into overlapping toes.

The imbalance that starts this whole process off can actually be induced by months or years of wearing improper footwear, but it can also be part of a person's genetic inheritance. That is to say, even someone who has taken scrupulous care of their feet and always worn shoes with a wide, high toe box can still end up developing hammertoe and then overlapping toes. It is therefore erroneous to always cite footwear as the cause.

 

Causes of Overlapping Toes – the Role of Footwear

Still, footwear can sometimes be a culprit. Tight shoes can lead to the formation of bunions caused by friction, and these in turn can cause overlapping toes to develop over time. This is particularly true when the bunions form on the big toe, which leads to the second toe not having enough space. As it cramps up, overlapping toes can result.

Any type of shoe that is overly narrow and smashes the toes together can also be a culprit. The worst shoe of all is one that it so tight across the toe box that even when a man or woman is sitting, the toes are being compressed. Less egregious but still quite problematic is the type of shoe that doesn't flex enough during motions such as walking, running, and jumping. Toes need to flex and move during these activities; if they can't do so, problems such as overlapping toe and many other foot conditions can develop.

Causes of Overlapping Toes -- More About the Inherited Structure of Your Feet

There are various genetic conditions or deformities of the foot that can, over time, cause overlapping toes to develop. These include:

  • Morton's toe (an unusually long second toe)
  • stiff tendons – these keep the foot from flattening against the ground
  • various other inherited foot conditions

What is problematic about the above conditions is that they cause an imbalance to occur in the way your foot tendons and muscles operate. These two bodily structures are supposed to function in concert to manage the stress and strain that standing, walking, running, jumping, and other motions place on your feet. Sometimes, though, the tendon will pull too hard and the muscle will not properly counter balance it; the reverse can also occur.

If you have an imbalance between the muscles and tendons in your foot or feet, it will lead you to walk off center or with another kind of gait that over time causes your toes to bend and align in non standard ways. This can cause your feet to cramp up, even if your shoes have toe boxes with plenty of room for them to spread out.

 

Overlapping Toes – Symptoms to Be Aware Of

Overlapping toes are usually obvious and can be diagnosed by visual inspection. They have the appearance of toes being smashed together to the point where they almost appear to overlap, hence the name.

Despite the ease with which overlapping toes can be detected and officially diagnosed, there are some signs and symptoms that usually or almost always accompany the condition. These include all of the following:

  • pain
  • inflammation
  • calluses on the toes
  • an altered gait when walking
  • toes rubbing attains the interior of the shoes
  • irritation due to friction
  • corns

The most common symptom of all is pain, followed by inflammation. As the condition progresses, if it remains untreated the patient's symptoms will grow progressively worse. The altered gait while walking tends to relieve pain to a small degree but also serves to worsen the severity of the condition over time and can even lead to yet more foot and leg problems – too many to recount here, in fact.

When corns develop, they are likely to be located on the "knuckle" area of the toe. Like many other symptoms that are associated with overlapping toes, the incidence of corns is caused by friction as the toes rub against each other and against the inside surface of a patient's footwear.

For these reasons it is of overwhelming importance that overlapping toes be treated as soon as it becomes clear that the condition is present. Moreover, treatment must be of the correct type and degree. Treatment that is not adequate or proper can, over the long term, do more harm than good and lead to a situation in which the patient would have been better off leaving the overlapping toes untreated.

 

Diagnosis of Overlapping Toes

A visual inspection is usually sufficient for a health care professional to render an official diagnosis of overlapping toes.

picture of overlapping toes

 

Prevention of Overlapping Toes

Several factors may work together to help prevent the formation of overlapping toes in the first place. These include:

  • wearing shoes with ample room for the toes
  • avoiding high heels whenever possible
  • using vitamin supplements to maintain healthy bones and joints

These prevention measures will of course be most effective when the overlapping toes are an acquired problem to begin with. When the overlapping toe condition is a result of genetic factors, it may not be possible to prevent them using such methods as those listed above.

 

Treatment for Overlapping Toes

The most common treatment of all is for patients with overlapping toes to be instructed to wear appropriate shoes or footwear. The most important criterion men and women need to pay attention to is the size of the "toe box." This is the portion of the shoe that houses the toes. Toe boxes should be roomy in all situations, never cramping the toes together or smashing them up against the walls of the shoe.

For those who have already developed a condition of overlapping toes, toe boxes must be even more roomy than should previously have been true. This is because the second most common treatment for overlapping toes is the use of various devices that all share a similar function: to keep the toes properly separated. These devices take up space in the toe box – therefore, the shoe must be extra generous in size in order to accommodate them.

It is not unusual for patients suffering from the condition of overlapping toes to purchase shoes a half size or even a full size wider than their usual shoe size in order to get enough girth in the toe box. Another option is to purchase shoes that are marked "W" for wide as an extra-wide toe box can sometimes provide the relief needed.

Treatment Options: Devices to Correct Overlapping Toes

Conservative treatment options for overlapping toes include both a recommendation to wear improved footwear and the use of corrective devices to keep toes separated. Both of these options are quite common and standard for patients with overlapping toes.

The most common treatment devices to correct the condition of overlapping toes are:

  • gel toe straighteners
  • toe "combs"
  • toe caps

What all these devices have in common is that they serve to keep the toes separated as the patient goes about his daily activities. Whether up and walking or sitting down at rest, the toes will be kept in the correct position and split apart from one another. Over time, the toes adjust and adapt to their new positioning and acquire it more readily, though the use of these devices may be required for a long time before the toes are able to "re-learn" their correct alignment.

Improved footwear in conjunction with corrective devices such as gel toe separators are generally quite successful at treating the condition of overlapping toes. By reducing friction, the devices immediate lessen a patient's experience of discomfort and pain, and over time the toes will learn to adapt to their new positions in which they do not overlap.

Treatment Options for Overlapping Toes – Surgery

This treatment option is not considered conservative. Surgical treatment of overlapping toes is usually reserved for the most serious cases of the problem. In many of these cases, a genetic deformity is at the heart of the problem – such deformities are much less likely to be amenable to conservative treatments such as using gel toe caps.

Deformities that may require surgical correction include the following foot and toe issues:

  • a highly contracted tendon in the foot
  • an extreme rotation of one or more toes
  • a dorsal – adduction deformity that causes an overlapping 5th toe

In general, there are two kinds of surgery that can be used to treat overlapping toes:

  • Butler's Surgical Correction
  • DuVries Correction

Since every case of overlapping toes is somewhat different, it is not possible to completely summarize the surgical procedures listed here. In general, the DuVries Correction involves releasing a certain ligament from tension by means of an incision and sometimes a second incision. The Butler's Surgical Correction also involves incisions after which the little toe can be moved far more freely in both a lateral and plantar direction.

Cautions About Surgery

Surgical procedures used to correct overlapping toes have a very low rate of complications, but this does not mean that they procedures are entirely without issue. Like any surgery, both the Butler's and DuVries correction procedures carry with them certain risks. These risks include infection and other complications.

Another issue to keep in mind is the fact that surgery to correct a condition of overlapping toes can be a very detailed and tricky procedure. It is not a simple matter that most surgeons can handle such as an appendectomy or other very common procedure.

Patients need to be sure to consult a surgeon the specializes not only in procedures involving the toes and feet, but also one that has extensive experience dealing with overlapping toes. It is a good practice to consult more than one such surgeon. Ask to see photographic documentation of the improvements a surgeon has achieved for his or her patients before you trust your precious toes to any one particular surgeon.

 

For More Information About Overlapping Toes

Many sites exist to provide additional information for patients suffering from overlapping toes. Some of the best resources available are listed here for your convenience.

The Podiatry Network's Page on Overlapping Toes

This page is located at The Podiatry Network, a comprehensive resource on foot health. One of the best features at this page is the opportunity at the bottom of the page to find a licensed podiatrist by zip code. This means that patients can find an appropriate health care professional in their local area, eliminating the bother of looking for a physician in sources that do not specialize in podiatry.

Overlapping Toes Page at Foot.com

Foot.com is another comprehensive source of information about optimal foot health. They offer a "foot pain identifier" resource which can help patients get at least an idea of what their problem might be. In addition, Foot.com offers a newsletter available by email to keep patients apprised of recent developments in the foot health field as well as new treatment options.

 



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