Common Digital Deformities

It’s not uncommon to see deformities in the toes of children. Typically, these conditions are inherited from the one of the parents. Digital deformities in children rarely resolve themselves, and they often grow worse over time without treatment.

Younger children and infants usually won’t notice deformities because symptoms rarely show until the children are more mature, but parents may notice misshapen or misaligned toes. As children grow older, the deformed toes may become stiff and immobile.

Below are some of the most common problems children may experience with their toes.

Underlapping toes

Underlapping toes are just as common with adults as they are with children. The most commonly affected toes are the fourth and fifth toes. This condition is often hereditary


Overlapping toes don’t always have a clear cause, but it’s possible they can be the result of the smaller muscles in the foot being too weak. These weak muscles, in conjunction with slightly misoriented joints below the ankle, can tighten the ligaments of the toes and cause them to stay curled.

This condition is more noticeable in children as they age because pressure from walking and running further aggravates the condition.

Treatment of underlapping toes

Treatment of underlapping toes varies depending on the age of the child. If the symptoms are minimal, the podiatrist may opt to monitor the condition over time to more accurately determine the best course of action. At times these, toes require surgery for treatment, as there are no conservative methods successful in correcting this condition.

Two common treatments for underlapping toes are:

  • For flexible underlapping toes -- releasing the tendon at the bottom of the toe to help it straighten out
  • For stiff, immobile clinodactyly toes -- releasing the tendon and removing a small portion of the bone may be the best course of action
  • Some clinodactyly patients experience tightened and hardened skin on the toe as well. In these cases, a skin transfer may be necessary.

    Overlapping toes

    An overlapping toe is a toe that has developed resting on top of the neighboring toe. The most common overlapping toes are the pinkie toe and the second toe (the one next to the big toe).


    The exact cause of overlapping toes isn’t certain. Some believe they may be the result of the positioning of the fetus in the womb as the body develops, and others believe it may be a hereditary deformity.

    Hammertoes and mallet toes

    Two more common digital deformities in children and adults are hammertoes and mallet toes. Hammertoes and mallet toes are caused by an imbalance in tendons on the top of the toe. This tendon imbalance is diagnosed as a hammertoe when the affected area is the middle joint of the toe, and is diagnosed as a mallet toe when the affected area is the joint closest to the toenail.

    When a patient with a hammertoe or mallet toe stands still, the toe bends towards the floor. In some cases, the toe is still flexible; in others, it is completely stiff.

    In children, these conditions are typically not painful, and the toes are still flexible, but hammertoes and mallet toes can grow stiff, develop calluses, and lead to thick and deformed toenails as the children mature and in adults.


    Hammertoes and mallet toes may be the result of, or aggravated by, a number of causes, including:

    • Tight shoes
    • A traumatic injury to the toes
    • Arthritis and diabetes
    • Morton’s toe (second toe is longer than the big toe)
    • Inherited genes causing the tendons and muscles in the area to develop incorrectly

    Treatment of hammertoes and mallet toes

    Depending on the severity of the condition, a your foot surgeon may be able to treat hammertoes and mallet toes with conservative methods. This typically involves cushioning and splinting the toes in a straightened position.

    More severe conditions may require surgery, which may include the following:

    • Tendon release - If the toe is still flexible, a released tendon may be enough to correct hammertoes and mallet toes
    • Bone removal - When the toe is rigid, removing a small portion of the bone may correct the condition.
    • Bone fusion - Some patients will require the two bones in the affected area to be fused together in order to restore the toe to a straightened position.