<s>[INST] I m a nursing student. While observing a youtube video, also saw overlapping toes deformity bilaterally on child. Child was undernourished and very small for age. Not familiar with this birth defect. Surgery was off the table at that time. What are possible treatments? [/INST] The most common reason for toes to be deformed at a young age is a tendon imbalance between the flexors and extensors of the foot. For example, having a high arch or a caves type foot, leads to the extensor tendons bow stringing and hammertoe formation. Using a custom orthotic from a foot and ankle specialist may help balance deforming forces. Others have advocated taping the toes in an improved position, but I never tape child Chat Doctor.  With a certain type of flatfoot, the fourth and fifth toes turn inward due to imbalance of intrinsic tendons of the foot. Although these may be cosmetically unappealing I would never consider surgery until all growth plates close after around 18 years of age, and usually don't ever cause negative symptoms </s>