Published: 19-08-2010, 11:58

Congenital overlapping fifth toe

This condition is nearly always recognizable at birth, but may become more fully manifest symptomatically in the first two to three years of life. The fifth toe is dorsiflexed, adducted, and slightly externally rotated, and literally comes to lie on the dorsal surface of the fourth toe (Figure 3.25).
Congenital overlapping fifth toe

Figure 3.25. An overlapping fifth toe.

Soft tissue contracture of the dorsal and medial structures of the fifth metatarsal phalangeal joint has been indicted as the cause of the deformity. Clinically, the toe not only lies dorsally and in an adducted position over the top of the fourth, but it cannot passively be reduced into its normal relationship. Those children who are symptomatic present with discomfort overlying the fifth toe with corns and painful calluses secondary to shoe wear. In general, surgical treatment should be reserved for only those cases in which substantial discomfort is present, and soft protective pads have failed. Most of the cases presenting with symptoms will eventually require surgical correction. Soft tissue releases, tendon rerouting, and metatarsophalangeal joint fusion provide the basis for reconstruction.
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