Overlapping 5th toe

What is overlapping 5th toe

Overlapping 5th toe occurs when the 5th toe lies on top of or overlaps the fourth toe. This is a common condition that can be present at birth. Tightening of the extensor digitorum longus (EDL) tendon is the most common cause of overlapping 5th toe. Once a child is walking and wearing shoes, the overlapping 5th toe can be painful and cause skin and nail issues. The condition often improves or gets better on its own without treatment as the child grows. Less than half of the cases of overlapping 5th toe require intervention.

How is overlapping 5th toe diagnosed?

A health-care provider will look at the toe's position and movement. X-rays of the foot are not needed.

How is overlapping 5th toe treated?

Initial treatment involves wearing wider shoes that have a higher toe box.

Physiotherapy and taping are not recommended as they will not change the position of the toe.

Overlapping 5th toe often corrects itself by 4 to 5 years of age without surgical treatment. Surgery requires skin flaps and de-rotating the toe. There is always a risk of recurrence of the overlapping 5th toe and vascular injury, so surgery is not performed before the 5 years of age.

Surgical treatment may be considered if:

• there is an associated deformity of the toes that prevents shoe wear or causes skin and/or nail issues
• the child is older than 5 years of age

At SickKids

SickKids does not accept referrals for children with an overlapping 5th toe who are under 5 years of age. Overlapping 5th toe often improves or resolves by 4 to 5 years of age. If the child is over 5 years of age and the overlapping 5th toe has not resolved, then the child can be referred at that time with photos of the feet and ankles attached to the referral.

References

Mosca, V. (2014). Principles and Management of Pediatric Foot and Ankle Deformities and Malformations (1st ed.). Wolters Kluwer Health