Deformities of the toes are common in the pediatric population.
Generally they are congenital in nature with both or one of
the parents having the same or similar condition. Many of
these deformities are present at birth and can become worse
with time. Rarely do children outgrow these deformities although
rare instances of spontaneous resolution of some deformities
have been reported.
Underlapping toes are commonly seen in the adult and pediatric
population. The toes most often involved are the fourth and
fifth toes. A special form of underlapping toes is called
clinodactyly or congenital curly toes. Clinodactyly is fairly
common and follows a familial pattern. One or more toes may
be involved with toes three, four, and five of both feet being
most commonly affected.
The exact cause of the deformity is unclear. A possible etiology
is an imbalance in muscle strength of the small muscles of
the foot. This is aggravated by a subtle abnormality in the
orientation on the joints in the foot just below the ankle
joint called the subtalar joint. This results in an abnormal
pull of the ligaments in the toes causing them to curl. With
weight bearing the deformity is increased and a folding or
curling of the toes results in the formation of callous on
the outside margin of the end of the toe. Tight fitting shoes
can aggravate the condition.
Forefoot supports such as gel toe straighteners, gel toe caps
and toe combs are often recommended to keep overlapping toes
apart. These effective devices are designed to reduce friction
to help relieve the discomfort.
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