summary Overlapping Toe is a rare congenital condition caused by contraction of the extensor digitorum longus in children that presents with a digit that overlaps another. Diagnosis is made clinically with adduction and slight external rotation of the affected digit while overlapping another digit. Treatment is usually passive stretching and buddy taping. Surgery management is indicated for patients who fail nonoperative treatment and remains symptomatic. Epidemiology Demographics evenly distributed between males and females Anatomic location the fifth toe most commonly affected usually bilateral Etiology Pathophysiology pathoanatomy due to contraction of the extensor digitorum longus Genetics often familial Presentation Symptoms may cause problems with shoe wear Physical Exam adduction and slight external rotation of the affected digit metatarsophalangeal joint is dorsiflexed the nail plate is smaller than the contralateral digit Treatment Nonoperative passive stretching and buddy taping indications first line of treatment Operative surgical correction indications fails nonoperative treatment and remains symptomatic technique Butler procedure perform racket handle incision then release the extensor digitorum longus tenotomy vs. dorsal capsulotomy vs. syndactylization with fourth toe (McFarland procedure)
QUESTIONS 1 of 1 1 Previous Next This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07PE.67) A 9-year-old girl has pain over the fifth toe that is aggravated by shoe wear. Clinical photographs are shown in Figures 28a and 28b. Treatment of this deformity should consist of QID: 6127 FIGURES: A B Type & Select Correct Answer 1 extensor digitorum longus tenotomy. 11% (51/472) 2 extensor digitorum longus tenotomy with dorsal fifth metatarsophalangeal (MTP) joint capsulotomy. 34% (161/472) 3 dorsal V-Y plasty for skin contracture, combined with extensor digitorum longus tenotomy and dorsal fifth MTP capsulotomy. 12% (55/472) 4 a dorsal and plantar racquet-shaped incision around the fifth toe, combined with extensor digitorum longus tenotomy and circumferential fifth MTP joint release (Butler procedure). 42% (198/472) 5 plantar proximal phalangeal resection. 1% (5/472) N/A Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (1) Podcasts (0) Login to View Community Videos Login to View Community Videos 2017 Current Solutions in Foot & Ankle Surgery The Crossover 2nd Toe: Steven Steinlauf, MD (CSFA #26, 2017) Steven Steinlauf Pediatrics - Overlapping Toe A 5/15/2017 511 views 5.0 (5)