Wednesday, October 17, 2012

Overlapping and Underlapping Toes

Toe deformities are common in children. These conditions are generally congenital, with one or both parents with these problems. Toe issues are typically present at birth and will become worse over time. Unlike children who are "pigeon-toed", children rarely outgrow this deformity.
In infancy, toe deformities are not usually a sign of another condition. For parents, it's usually a cosmetic issue. But as the child grows, the toes transform from flexible to rigid and become symptomatic of another condition. Many toe deformities will respond to conservative treatment. Traditional treatment has been digital splitting and exercises, but those often do not lead to good outcomes. As the deformities progresses and the toes become more rigid, surgery is generally the only option.
Underlapping toes can be seen in both children and adults and typically affects the fourth and fifth toes. A special type of underlapping toes is called congenital curly toes, and is common among families. Toes three, four, and five may be affected.
The cause of the deformity is unknown, but may be due to an imbalance in muscle strength of the small muscles of the foot. Combined with a small abnormality in the placement of the joints of the foot below the ankle joint called the subtalar joint, it creates a pulling of the ligaments in the toes, causing them to curl. Weight bearing increases the deformity and the folding of the toes results in the formation of callus on the edge of the toe. Tight fitting shoes aggravate this condition.
Treatment depends on the age of the patient, degree of the deformity, and symptoms. When symptoms are minimal, most podiatrists will recommend waiting and seeing how the condition progresses. If surgery is required, the degree of the deformity determines the procedure. A flexible toe will only require a simple release of the tendon, but a rigid toe may necessitate the removal of part of the bone.
Overlapping toes are identified by one toe that lies on top of another toe. The fifth toe is most often affected, but the second toe can be as well. The cause of this deformity is not known as well, although it is speculated that the position of the fetus in the womb during development is a potential reason. Sometimes overlapping toes are seen in families.
Treatment for overlapping toes depends on how quickly the condition is diagnosed. For infants, passive stretching and adhesive taping is commonly prescribed. This treatment can take 6 to 12 weeks and recurrence of the deformity is likely. Like underlapping toes, this problem will rarely correct itself. Occasionally as the individual grows, the deformity will go away. If surgery is required, a skin plasty is required to release the contracture of the skin associated with the toe. A tendon release and release of the soft tissue around the joint at the base of the toe may also occur. Cases that are severe may require the toe to be held in place with a pin. The pin exits the tip of the toe and may be left in place for up to three weeks. During recuperation the patient must limit their activities and wear a surgical shoe or removable cast. Excessive movement will greatly affect the outcome of how the toe looks. Following removal of the pin splinting of the toe may be required for another two to three weeks.
If you have underlapping or overlapping toes, call our Glastonbury or Middletown office to make an appointment.
Ayman M. Latif, DPM
Connecticut Foot Care Centers
Foot Deformity Doctor in CT
Podiatrist in Glastonbury and Middletown, CT
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