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Dr. Harvey R. Danciger

Overlapping and Underlapping Toes

Foot deformities can not only be unsightly and embarrassing, but also cause significant discomfort. Abnormalities such as overlapping and underlapping toes are often seen in pediatric patients. While there is no known direct cause for this problem, it is generally attributed to hereditary foot structures. In some cases, it is believed to develop when babies have limited space in the womb and the toes become crowded, and in others improper footwear could have aggravated the problem. Despite not finding a particular cause to focus on, we still have very effective ways of treating this toe deformity. The differences between underlapping and overlapping are subtle but important to understand.

Underlapping Toes

This type of deformity commonly affects the fourth and fifth toes and is seen in adults and children alike. There is a special type of underlapping toes called congenital curly toes, which is commonly seen among families. In this case, the third, fourth and fifth toes can be affected. An imbalance within the small muscles of the foot can abnormally pull the ligaments of the toes, causing them to curl and be forced underneath the adjacent toes. Improper footwear can also cause the underlapping to worsen over time.

Overlapping Toes

This is when one toe lies on top of an adjacent toe and the fifth or second toes are the most common ones affected. It is thought that the position of the baby in the womb can lead to this deformity, and it may run in families. A severe bunion deformity can also push the second toe to overlap on top of the third toe. 

Treatment Options

Any type of pain or discomfort in the toes should be given prompt attention and treatment. Ignoring your symptoms can aggravate the condition, cause a breakdown of tissue, and lead to infection and significant discomfort. When symptoms are minimal, the first step is often to eliminate all sources of pressure. This can be accomplished by wearing shoes that have ample room in the toe box, both in depth and width. When toes are flexible, treatments such as toecaps, straighteners and combs are effective treatment options. With children, stretching and taping can help, but recurrence of the deformity is common. There may also be specific exercises that can keep your toes from becoming more fixed in place. 

Unfortunately, surgery is often necessary to permanently correct overlapping and underlapping toes. There are times, even when it is diagnosed and treated early, that conservative methods just do not prevent the condition from worsening. Taping and straighteners often become a temporary fix, as toes tend to revert back to their overlapped or underlapped position. The degree of your deformity will determine the surgical procedure needed. In some cases, a small release of a tendon helps the toe to realign. In more severe situations, it may be necessary to insert a pin into the toe to hold it in the correct position. When a toe is rigid, surgery may involve the removal of part of the bone to allow the toe to properly realign with the rest of the toes. Recovery can take up to six weeks. You may need to limit your activities or stay off your foot and wear a boot or cast while the toe heals.

Since these types of conditions often require surgery in order for function to be restored and symptoms alleviated, we encourage you to contact Dr. Harvey Danciger as soon as possible to prevent future pain and irritation. Call our Palm Desert, CA office at (760) 568-0108 or request an appointment online.


Dr. Harvey Danciger
Dr. Harvey Danciger is a podiatrist and foot surgeon in Palm Desert, CA specializing in the foot and ankle