Repair of Overlapping Toes
Overlapping Toes: - involves an dorsal-adduction deformity of the 5th toe; - other components of the deformity include external rotation of the digit, contracture of the EDL tendon; - in some cases there may be dislocation of the MTP joint; - often the deformity is familial and bilateral.

Clinical findings: - the deformity is asymptomatic, but it can cause difficulty with shoe wear and pain over the dorsum of the toe; - a dorsal callus is commonl; - in some cases, there will be an associated bunionette.

DuVries Correction: - may use lateral incision from osteotomy or may make second incision in 4th interspace; - release the EDL, dorsal joint capsule, and medial collateral ligament.

Butler's Surgical Correction: - create a dorsal racket incision over the little digit, centered over the EDL tendon; - this allow the toe to be derotated; - a second "handle" incision is made on the plantar aspect of the original wound, which is brought laterally and proximally; - this incision allows the toe can now be moved laterally and plantarly; - release the contracted extensor tendon and the dorsal capsule; - in some cases, the plantar capsule will have to be released thru the dorsal capsule; - for a good surgical result, the toe must passively lie in a corrected position; - forced correction may place tension on the digital vessels; - if residual deformity is present, more capsule needs to be excised; - skin sutures can help keep the toe in a derotated position.

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