Many disorders can affect the joints in the toes, causing pain and preventing the foot from functioning normally. People of all ages can experience these toe deformities. These deformities can be present from birth and usually progress into adulthood.

The crossover toe is a condition in which the second toe drifts toward the big toe and eventually crosses over and lies on top of the big toe. It can occur at any age, but is most often seen in adults. Crossover toe is often seen with bunions, a second toe that is longer than the big toe, an unstable arch or a tight calf muscle.

Overlapping toes are a deformity of the toes, where one toe is lying on top of another toe (other than the big toe). The fifth toe (smallest) is the most commonly affected. Overlapping toes most commonly appear in newborns and are thought to develop in the womb, possibly due to the position of the baby.

Underlapping toes is a deformity that involves the fourth and fifth toes. Seen in persons of all ages, its exact cause is unknown, but is thought to be caused by an inherited trait in the structure of the foot. A special form of underlapping toes is called clinodactyly or congenital curly toes. Curly toes are fairly common and frequently run in families, and one or more toes may be involved.

Causes
These deformities of the toes are present in all ages. Generally, they are congenital, many being present at birth and can become worse with time. These conditions sometimes do not cause problems or symptoms but rarely do children outgrow them. The exact cause of these deformities is not known or clear. It is suggested that a possible cause is an imbalance in muscle strength of the small muscles of the foot. This is aggravated by an abnormality in the orientation on the joints in the foot leading to an abnormal pull on the ligaments in the toes. This causes them to curl, overlap or underlap.

Most parents are more concerned about the appearance of the toes, rather than the functioning of the toe. In infancy, passive stretching and adhesive tapping is most commonly used. This may require six to 12 weeks to accomplish straightening of the toe and the deformity may reoccur. Rarely will the deformity correct itself. As the child grows up, these deformities progress from a flexible to a more rigid deformity and can become progressively noticeable and painful.

Symptoms
These toe deformities (contractures) can come in different degrees of severity -- from slight to severe and the symptoms can do the same. With weight bearing, the deformity is increased and a folding or curling of the toes results in the formation of callous on the outside of the toe. Tight-fitting shoes can aggravate the condition. Many patients complain about toe pain on the toe joint where it bends, thick toe callouses, difficulty with walking and other activities, difficulty fitting shoes, worsening toe deformity over time, pain at the ball of the foot and unsightly appearance. Diabetic patients can develop ulcerations on the ends of their toes secondary to toe deformities and the pressure that can result from shoes.

The condition is diagnosed by the podiatrist by physical examination and history. X-rays and additional testing can also be done at the doctor's office

Treatment
The age of the patient, degree of the deformity and symptoms determine if and when treatment is given. If symptoms are minimal, a wait and see approach is acceptable. Treatment depends on your overall health, symptoms and severity of the toe deformity. When treatment is required, the degree of the deformity determines the level of correction.

Effective, conservative treatment depends on how early the diagnosis is made. It consists of padding and strapping the toes into a corrected position. It can also involve changing shoe type and style to prevent pressure on the toe. This treatment may relieve the symptoms but will not correct the deformity. In fact, many of these deformities are unresponsive to conservative treatment. Even after a prolonged course of splitting and exercises, many may have little results.

When the deformity is flexible, a simple release of the tendon on the bottom of the toe will allow for straightening of the toe. The toe is splinted until it heals straight. As the deformity becomes more rigid, or hard, removal of a small portion of the bone in the toe may be necessary. If skin is tight over the toe, then skin correction may be needed too.

In some cases, the toe may also require that a pin is placed in the toe to hold the toe in a straightened position. The pin which exits the tip of the toe, may be left in place for up to three weeks to allow it to heal straight. The pin can be easily removed in the doctor's office with minimal discomfort and after that the toe is splinted for an additional two to three weeks. On occasion, fusion of the last two bones in the toe may be necessary so when the bone heals it forms a single bone and the toe remains in a straightened position.

Many years ago, amputating a part of the toe was also an option, however that is not often done now. Healing times range from two to six to eight weeks -- and are dependent on the procedure that was done. If you notice you or your child has an overlapping or underlapping toe, visit the podiatrist to have it evaluated and possibly corrected if you see symptoms.

o For more information email foothealth242@gmail.com or visit www.apma.org. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates Centre, Albury Lane, telephone 394-5820, or Lucayan Medical Centre on East Sunrise Highway, Freeport Grand Bahama, telephone 373-7400.

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