Overlapping Toes


OVERLAPPING  TOES
By:  Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.
           

PROBLEM:

Drifting of the second toe towards the big toe, causing pain, deformity and early development of an overlapping second toe over the big toe.

CAUSE:

  1. Trauma to the second toe joint causing inflammation to that region.
  2. Inflammation of the nerves on the ball of the foot (neuroma).
  3. Long second toe or second metatarsal, causing a hammertoe and excess stress on the ball of the foot.
  4. Weakness or tearing of the ligament holding the second toe straight.
  5. Pressure on the second toe from a bunion deformity.
  6. Pressure on the second toe due to a crooked big toe (hallux deformity).
  7. Tearing of the ligament (plantar plate) on the ball of the foot.
  8. Connective tissue disorders (i.e. rheumatoid arthritis, psoriatic arthritis).

SIGNS & SYMPTOMS:

  1. Space between second and third toe while weightbearing.
  2. Pain to the second toe that increases with walking.
  3. Difficulty walking barefoot.
  4. Unable to wear heels without pain.
  5. Drifting of the second toe towards or over the first toe (overlapping toe).
  6. Hammertoe of the second toe.
  7. Neuritis (inflamed nerve causing numbness, burning and tingling).
  8. Associated with bunion deformity and/or crooked big toe.
  9. Swelling of the second toe and/or ball of the foot.

TREATMENT:

  1. Taping of the toes to lessen the deformity (may lessen the pain temporarily but not change the deformity).
  2. Anti-inflammatories to decrease inflammation.
  3. Stiff-soled shoes to prevent toe bending.
  4. Flat shoes to lessen the stress on the second toe joint.
  5. Surgery to realign the joint and possibly remove the nerve to achieve full recovery.

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Below is a photograph a a severe overlapping bunion and hammertoe deformity. At this point in the mechanical process the digits, especially the second digit, is dislocated from its articulation with the longer bone in the foot called the metatarsal. Severity of these deformities is multi-factorial involving genetics, altered mechanics with soft tissue contractures, and bad shoegear.

 

 

Intraop pic before and after chevron bunionectomy, repair 2nd mpj and fusion 2nd toe

Pictured above is a foot after surgical correction of the bunion deformity of the great toe and hammertoe correction of the second toe. The plastic balls at the top of the second toe is covering a wire that holds the position of the second toe into the longer bones (metatarsals) of the foot so that the soft tissue contractures heal in the correct place. Depending on the deformity, the wire will stay in place for a period of 4-6 weeks and then are removed.

Before and after bunionectomy with repair of second toe

Pre and Postop X-ray of Phalangeal osteotomy with fusion of second toe for bunion and cross-over second digit

Intraop Pics of Hammertoe correction 

This patient had a bunion that is corrected. Also, the second toe overlapped the big toe. We have released the medial side to stop the pull towards the big toe. Below, we are putting in sutures on the lateral side to aid correction and maintenance of the reduction of the second toe joint.

After the repair of the 2nd MPJ, we perform a PIPJ Fusion and temporarily pin the second toe across the MPJ to allow healing of all bone and soft tissue. This pin is taken out in the office at approximately 6 wks.

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