What is the initial management for a 15-month-old with a cross-over toe (also known as overlapping toe)?

Initial Management of Crossover Toe in a 15-Month-Old

For a 15-month-old with crossover toe deformity, initial management should be conservative with observation and reassurance, as most congenital toe deformities in young children correct spontaneously with normal ambulation and growth. 1

Conservative Management Approach

Observation Period

• Watchful waiting is the primary strategy for children under 2-3 years of age, as pediatric overlapping and crossover toe deformities commonly self-correct with normal walking development 1
• Continue observation until at least age 6 before considering any intervention, unless symptoms develop 1

Non-Operative Interventions (If Symptomatic)

If the deformity persists or becomes symptomatic during the observation period, consider:

• Strapping or taping techniques to gently guide toe alignment 1
• Splinting devices applied intermittently to encourage proper positioning 1
• Shoe modifications including:
  • Wide toe box footwear to accommodate the deformity 1
  • Soft, flexible shoes made of natural materials that allow normal foot development 2
  • Avoiding tight or constrictive footwear that could worsen the deformity 2

Footwear Recommendations for Young Children

• Allow barefoot walking indoors when safe to promote normal muscular and joint development 2
• Shoes are not always necessary indoors at this age, as barefoot ambulation provides proprioceptive feedback and supports natural foot growth 2
• When shoes are needed, select lightweight, flexible footwear with adequate room for toes 2

When to Intervene

Indications for Treatment

Intervention is warranted only if:

• Persistent pain develops with walking or shoe wear 1
• Significant footwear difficulty that impairs function 1
• Deformity persists beyond age 6 with functional limitations 1

What NOT to Do

• Do not pursue surgical intervention at 15 months of age - surgery is indicated only after exhaustive conservative measures have failed in older children 1
• Avoid aggressive early treatment, as the natural history favors spontaneous improvement 1

Follow-Up Strategy

• Re-evaluate every 3-6 months to monitor progression or resolution of the deformity
• Assess for development of pain, skin breakdown, or functional impairment at each visit
• Measure feet regularly (every 2-4 months) to ensure proper shoe fitting as the child grows 2