Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
Quick Answer: Overlapping toes in adults are caused by plantar plate insufficiency, bunion deformity pushing adjacent toes, or congenital toe deformity. Conservative care (toe spacers, wider shoes, buddy taping) manages symptoms. Surgery (plantar plate repair, proximal phalanx osteotomy, toe shortening) corrects established deformity.
Types of Overlapping Toes
Crossover second toe (hallux override): The second toe rides over the big toe, caused by plantar plate insufficiency and often associated with hallux valgus. The most functionally significant overlapping toe deformity in adults. Fifth toe varus (tailor’s bunion variant): The fifth toe rides over or under the fourth toe. May be congenital or acquired from narrow shoe pressure. Underlapping toes: Lesser toes that curl under adjacent toes — related to flexor tendon contracture and hammertoe deformity. Adductovarus second/third toe: Toes that adduct (angle toward the big toe) and rotate simultaneously.
Conservative Management
Toe spacers (silicone or foam) placed between the affected toes maintain alignment, relieve pressure, and prevent skin irritation from toe-on-toe contact. Buddy taping with a small foam pad between the digits can correct mild deformities during activity. Wide toe box shoes are mandatory — any shoe that compresses the forefoot accelerates overlapping toe deformity progression.
Orthotics with metatarsal accommodation reduce the forefoot loading that drives plantar plate insufficiency in crossover toe cases. Activity modification and shoe changes can stabilize mild to moderate deformities indefinitely.
Surgical Correction
Surgery addresses both the deformity and the underlying structural cause. For crossover second toe: plantar plate repair with Weil osteotomy and simultaneous bunion correction (if present) provides excellent correction. For fifth toe varus: proximal phalanx osteotomy or simple excision of the proximal phalanx base (Ruiz-Mora procedure). For congenital underlapping toes: flexor to extensor tendon transfer at the proximal phalanx base.
Dr. Tom's Product Recommendations
PowerStep Pinnacle Insoles
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For overlapping toes driven by plantar plate insufficiency (crossover toe), PowerStep Pinnacle insoles with metatarsal accommodation reduce the loading that progressively weakens the plantar plate. The arch support component controls the overpronation that contributes to bunion formation — the most common driver of crossover toe.
Dr. Tom says: “For my crossover toe patients not ready for surgery, PowerStep insoles with a metatarsal pad placed just proximal to the second metatarsal head is the cornerstone of conservative management. Controls both the arch mechanics and the forefoot loading. Slows progression significantly in many patients.”
Early crossover toe, metatarsal offloading, bunion-related overlapping toe
Stage 3 complete dislocation (needs surgical correction); tight narrow shoes negate insole benefits
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✅ Pros / Benefits
- Conservative care with toe spacers and wide shoes manages most mild-moderate cases
- Surgical correction is highly effective with excellent long-term results
- Addressing concurrent bunion deformity prevents surgical recurrence
- Recovery from most overlapping toe surgeries is 6–8 weeks in a flat shoe
❌ Cons / Risks
- Progressive without treatment — deformity invariably worsens if left unaddressed
- Surgery requires concurrent bunion correction for crossover toe — adds recovery complexity
- Congenital deformities in adults may have developed compensatory adaptations that complicate correction
Dr. Tom Biernacki’s Recommendation
Overlapping toes are cosmetically bothersome but also functionally limiting — getting shoes to fit is genuinely difficult. I always stage the treatment: wide shoes and toe spacers first, then orthotics to control the driving mechanics, and surgery when conservative measures fail to control progression or pain. The mistake is waiting until the deformity is rigid and the plantar plate is completely ruptured — address it early when options are broader.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Can overlapping toes be fixed without surgery?
Mild to moderate overlapping toes can be managed with wide shoes, toe spacers, and buddy taping. Severe or rigid deformities require surgery for correction.
At what age do overlapping toes get worse?
Overlapping toes are progressive and typically worsen with each decade after the causative deformity (bunion, plantar plate insufficiency) develops. Early intervention stabilizes the condition.
Is overlapping toe surgery painful?
Modern overlapping toe surgery uses regional anesthesia and is performed as an outpatient. Most patients describe postoperative discomfort as manageable with oral pain medications for the first 3–5 days.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)