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Updated: Jun 15 2021

Overlapping Toe

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https://upload.orthobullets.com/topic/4080/images/Clinical photo_moved.jpg
  • 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)
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