Too many toes sign from tibialis posterior tendon dysfunction

(A) Normal posterior view of the foot.
(B) Evidence of arch collapse with "too many toes sign." In this instance, even a portion of the great toe is visible from directly behind the patient.
(C) Example of the "too many toes sign." When the feet are inspected from behind, more toes are visible on the left than the right. This is caused by forefoot abduction secondary to the loss of support from the posterior tibialis tendon and collapse of the longitudinal arch. Note the hindfoot valgus (angled black line) and medial ankle swelling (arrow) of the left foot compared with the right.