What Are Overlapping and Underlapping Toes?

Overlapping toes occur when one toe lies on top of its neighbor, while underlapping toes (sometimes called “curly toes”) occur when a toe tucks beneath the adjacent toe. These deformities can affect any toe, but the fifth (pinky) toe is most commonly involved. They may be present at birth (congenital) or develop later in life due to footwear, trauma, or other foot conditions.

While sometimes only a cosmetic concern, overlapping and underlapping toes can cause pain, difficulty wearing shoes, and progressive foot problems if untreated.

Causes

Several factors can contribute to overlapping or underlapping toes:

  • Genetics – inherited foot structure or congenital deformity

  • Ill‑fitting shoes – narrow toe boxes, high heels, or rigid shoes that crowd the toes

  • Other foot conditions – bunions, hammertoes, flat feet, or high arches

  • Biomechanics – overpronation (rolling inward) or abnormal gait patterns

  • Arthritis – joint inflammation altering toe alignment

  • Trauma – injuries or dislocations affecting toe position

  • Neuromuscular conditions – imbalances in tendons or muscles controlling the toes

Symptoms

Common symptoms include:

  • Visible toe crossing (over or under its neighbor)

  • Pain or discomfort, especially in shoes

  • Redness, swelling, or irritation at pressure points

  • Corns or calluses where toes rub together or against shoes

  • Difficulty walking or altered gait mechanics

  • In severe cases, sores or skin breakdown

Diagnosis

Diagnosis is usually straightforward:

  • Physical exam – assessing toe position, flexibility, and tenderness

  • X‑rays – to evaluate bone alignment and rule out arthritis or fractures

  • Medical history – reviewing footwear, family history, and prior injuries

Nonsurgical Treatment

Early and flexible cases often respond well to conservative care:

  • Footwear changes – wide toe boxes, soft uppers, and low heels

  • Toe spacers or separators – to reduce rubbing and encourage alignment

  • Padding or taping – to protect skin and gently guide toes into position

  • Orthotics – custom inserts to correct gait and relieve pressure

  • Toe splints or buddy taping – especially effective in infants and young children

  • Exercises and stretching – to strengthen toe muscles and improve flexibility

  • Physical therapy – for muscle balance and gait correction

When is Surgery Needed?

Surgery may be considered when:

  • The deformity is rigid and painful

  • Conservative treatments fail to relieve symptoms

  • Shoe wear and walking are significantly impaired

Surgical options may include:

  • Soft tissue release – loosening tight tendons or ligaments

  • Osteotomy – realigning or shortening bones

  • Tendon transfer – balancing muscle pull on the toe

  • Arthroplasty or fusion – in severe or arthritic cases

  • Excision procedures – occasionally for severely deformed fifth toes