Butler Procedure for Overlapping Fifth Toe
B. David Horn
ANATOMY
There are seven main components:
The fifth toe may be smaller than normal.
The fifth toe is adducted toward the fourth toe.
The fifth metatarsophalangeal joint has a dorsiflexion contracture.
The phalanges of the fifth toe are rotated laterally.
The fifth extensor digitorum longus tendon is shortened.
The fifth metatarsophalangeal joint is dislocated dorsally.
The skin in the fourth web space is contracted.
PATHOGENESIS
The exact pathogenesis is unknown, but the condition is believed to be secondary to a congenital contracture of the fifth extensor digitorum longus tendon.1
NATURAL HISTORY
This condition rarely causes pain or difficulty in shoe wear in children younger than 10 years of age.
In older children and adolescents, there will be painful dorsal callosities about 50% of the time.
There may also be difficulty in finding shoes that fit appropriately in older children and adolescents.
FIG 1 • A,B. Frontal and lateral image of overlapping fifth toe. (Picture courtesy of Richard Davidson, MD.)
Parents are frequently concerned about the cosmetic appearance of the foot.
PATIENT HISTORY AND PHYSICAL FINDINGS
The fifth toe will be dorsiflexed, adducted, and laterally rotated. It will not be passively correctable into a neutral position (FIG 1A,B).
A careful neurovascular examination should be performed and documented.Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
