summary Overlapping Toe is a rare congenital condition caused by contraction of the extensor digitorum longus in children that presents with a digit that overlaps another. Diagnosis is made clinically with adduction and slight external rotation of the affected digit while overlapping another digit. Treatment is usually passive stretching and buddy taping. Surgery management is indicated for patients who fail nonoperative treatment and remains symptomatic. Epidemiology Demographics evenly distributed between males and females Anatomic location the fifth toe most commonly affected usually bilateral Etiology Pathophysiology pathoanatomy due to contraction of the extensor digitorum longus Genetics often familial Presentation Symptoms may cause problems with shoe wear Physical Exam adduction and slight external rotation of the affected digit metatarsophalangeal joint is dorsiflexed the nail plate is smaller than the contralateral digit Treatment Nonoperative passive stretching and buddy taping indications first line of treatment Operative surgical correction indications fails nonoperative treatment and remains symptomatic technique Butler procedure perform racket handle incision then release the extensor digitorum longus tenotomy vs. dorsal capsulotomy vs. syndactylization with fourth toe (McFarland procedure)