Updated: 6/15/2021

Overlapping Toe

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  • 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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Flashcards (2)
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Questions (1)

(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:
1

extensor digitorum longus tenotomy.

9%

(30/316)

2

extensor digitorum longus tenotomy with dorsal fifth metatarsophalangeal (MTP) joint capsulotomy.

35%

(112/316)

3

dorsal V-Y plasty for skin contracture, combined with extensor digitorum longus tenotomy and dorsal fifth MTP capsulotomy.

12%

(37/316)

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%

(132/316)

5

plantar proximal phalangeal resection.

1%

(3/316)

N/A E

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Evidence (2)
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EXPERT COMMENTS (4)
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