Information for Families – Overriding 5th toe

Nev Davies

Reading Children’s Orthopaedic Unit

What is an overriding 5th Toe?

This uncommon condition is usually present at birth but can become more noticeable in the first few years. The 5th little toe sits on top of the 4th toe, curling inwards. Sometimes it occurs just in one foot, sometimes in both.

What are the symptoms of an overriding 5th Toe?

The main concern is the look of the toe, but in many people these toes don’t cause too many problems. Sometimes, symptoms such as rubbing, hard skin, blistering or pain can occur, as well as difficulties getting shoes to fit.

What causes this?

We do not know exactly what causes the toe to sit like this. Although it has been noted that the condition can affect several generations, which implies that it is sometimes passed on from parent to child (inherited).

What is the natural history of this condition?

If the foot remains asymptomatic (no symptoms) and pain free we tend to observe and leave well alone. We would encourage moisturisation after baths and wide fitting shoes for comfort.

How can it be treated?

Treatment options are quite binary.

Option A. Leave alone and observe. We tend to do this in asymptomatic or patients who present noticeably young (under the age of 4).

Option B. Surgery to straighten the toe. If the toe does become symptomatic, surgery is usually advised before school age. The operation is done under a general anaesthetic as a day case procedure. At the time of consent, we would discuss the procedure in detail with you, including the benefits and the risks of the surgery, as well as the post-operative care.  Please see the separate information leaflet regarding surgery.

Surgical Reconstruction

What does the operation involve?

The operation is done under a general anaesthetic as a day case procedure. We also numb the toe with local anaesthetic. It is quite a big operation through a large scar (see blue line on photo.) It requires a large soft tissue release of all the tight structures to get the toe straight. Dissolvable stitches are used as well as paper stitches and a big wool and crepe dressing is applied.

What is the aftercare?

It is extremely important to elevate the foot for 72 hours after the operation. This helps the swelling settle and to aid healing. A temporary splint (half plaster) with a heel-walking shoe is used. Crutches are useful to get around, but not essential, particularly at school. Patients are seen in clinic around 2 weeks after the operation to check the scar is healing and to redress the wound. Most patients would slowly wean into a shoe with a nice wide toe box at this stage. Return to sports and activities is at around 4-6 weeks.

What are the success rates?

Most families are very happy with the result. There is always a small chance of recurrent tightness, usually due scar tissue build up and the toe reverts to its overriding position. In these cases, I would refer to a plastic surgeon for an additional opinion.

What are the risks of surgery?

The risks of surgery are small and include the general surgical risks of any surgery. These include infection, ugly scar and skin numbness. The more specific risks of this operation include recurrent deformity, tendon damage and loss of blood supply to the toe. I will discuss all this in detail with you before we proceed.

 

 

 

Contact Form

    Your Name*

    Contact Email*

    Contact Number*

    Your Message

    Recent News

    Information for Families – Overriding 5th toe

    Nev Davies Reading Children’s Orthopaedic Unit What is an overriding 5th Toe? This uncommon condition is usually present at birth but can become more noticeable…

    Nev talking at the 2nd International Child and Adolescent Knee Congress

    Nev is delighted and honoured to have been invited to Talk at The 2nd International Child and Adolescent Knee Congress in Sheffield later this year….

    My Second ACL Reconstruction & High Tibial Osteotomy

    this article was originally posted on physiolabinfohub.com One of our patients, Mark Abbott, explains how a severe knee injury at the age of 18 resulted…

    Testimonials

    I had a knee arthroscopy to removed and clean up damaged cartilage after 6 years of repeated injury and dislocation from playing sport. I had been putting off the idea of surgery, but it was a great decision to finally get it seen to. I couldn't be happier with the results so far, and in less time than expected. Running, squats and climbing stair caused pain, and a lot more cracking than a 22 year old's knee should have! Now 2 weeks after the op, and following the physio exercises given after the operations, I am driving and climbing/ descending stairs without a problem and on the road to a full recover and hoping to get back to regular exercise within the next few weeks.

    I came to see you approximately four years ago and talked through the pros and cons of having an ACL replacement following an ACL rupture in my right knee I suffered playing an ill- advised game of beach volley ball on holiday in Antigua. I went ahead with the operation which you successfully performed at the Dunedin Hospital in Reading, I got on with my rehab and I now just wanted to let you to know that I will be running the London Marathon in three weeks (and raising money for Whizz-Kidz a disability charity for young people.) This letter is just a belated thank you for enabling this to happen.

    Mr Davies is a fantastic surgeon he put in a half knee joint in my right knee I have no problem with it ever since the operation in August last year. I have no more pain in my knee at all. I would recommend him to anyone.

    Mr Nev Davies has a very pleasant manner and was easy to talk to. The service provided was efficient, quickly identified the problems I had and was able to recommend treatment close to where I live.

    Memberships

    • General Medical Council (GMC) Membership
    • Royal College of Surgeons of England (RCS(Eng.))
    • British Medical Association (BMA)
    • British Orthopaedic Association (BOA)
    • British Society of Children's Orthopaedic Surgery (BSCOS)
    • British Association of Surgery of the Knee (BASK)
    • AO European Trauma Group
    • British Orthopaedic Sports Trauma and Arthroscopy Association (BOSTAA)