What does 'Too many toes' mean?

This may sound a bit odd and the sign is not related to how many toes you have, so its not some sort of congenital deformity of the foot. It is a sign that clinicians commonly observe and comment on when looking at the foot or looking at someone walking. When someone is standing upright and you look at them from behind and look towards the front of the foot, you can normally see the little toe and maybe the next one on the outside when looking. In some people you can see more than the lateral few toes from behind – they call this the too many toes sign. It refers to how many toes are observable on the outside when looking at someone standing when observed from behind. A few toes are normal, all of the toes is very abnormal and some of the toes would be considered somewhat abnormal. As well as standing, the too many toes sign can also be seen when people are walking.

It is of some debate as to if there is a lot of toes being visible on the outside when observed from behind is of any clinical significance or not? Some of the people with this sign may have a externally rotated gait and in most people this is quite normal and of no consequence. Other people with this might have a severely overpronated foot and the forefoot abducts significantly to cause the too many toes sign. This particular problem could be quite painful and disabling. In cases like this you could consider that the sign is not a problem on its own, but is an indication that there is an underlying problem of the overpronation. It is more a symptom of the problem rather than a problem on its own.

A problem with the use of the words, too many toes sign is that it is nocebic and conjures up the image in a persons mind that they have some sort of clinical problem when they do not really. The use of words to describe those sorts of conditions have to be chosen carefully so as not to unduly alarm people. If the problem does need to be treated because it is a symptoms of an underlying problem then attention needs to be directed at that. If the overpronation is the reason for the sign and there is a need to treat this, then there are options. Not all cases of overpronation need to be treated, but when they do the most common intervention is to use a foot orthotic. These can be custom made for the individual or they could be an over-the-counter type of mass produced type. Good supportive shoes can also be helpful. Depending on the cause, there are a number of exercises that can be useful such as the short foot exercises and exercises at the hip to increase external rotation of the leg. If you think you or someone you know might have the too many toes sign, then get to a health professional experienced in this problem to get some advice.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.