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Curly Toes

Curly toes
Objectives
  1. Define curly toe
  2. Discuss the natural history of curly toes
  3. Discuss treatment of curly toes

Discussion
Curly toes are present at birth, mostly involving the lateral toes. The distal phalanx is flexed and may be deviated medially or laterally. Contracture of the long flexors appears responsible, the cause of the contracture is unknown. Curly toes are asymptomatic in children, but their appearance is vexing to many parents. They may cause pressure symptoms from shoewear later in life. On exam the distal joint can be extended if the proximal interphalangeal joint is flexed, indicating contracture of the long flexor. The adjacent toe may be overriding. Taping may improve the posture temporarily, but the deformity usually recurs when taping is discontinued. Both simple tenotomy and transfer of the long flexor to the extensor apparatus (Girdlestone-Taylor procedure) have been employed for surgical correction. In a double blind study, there was not difference in results, and simple tenotomy suffices. As a result of a longterm study, Biyani advocates no treatment before age 6, as the rate of spontaneous correction is so high. If treatment is for some reason necessary at that time, tenotomy of the long toe flexor is sufficient.

References
  1. Biyani A, Jones DA, Murray JM. Flexor to extensor tendon transfer for curly toes. 43 children reviewed after 8 (1-25) years. Acta Orthopaedica Scandinavica 1992; 63( 4): 451-4.
  2. Hamer AJ, Stanley D, Smith TW. Surgery for curly toe deformity: a double-blind, randomized, prospective trial. Journal of Bone & Joint Surgery -British Volume 1993; 75( 4): 662-3.
  3. Pollard JP, Morrison PJ. Flexor tenotomy in the treatment of curly toes. Proceedings of the Royal Society of Medicine 1975; 68( 8): 480-1.
  4. Ross ER, Menelaus MB. Open flexor tenotomy for hammer toes and curly toes in childhood. Journal of Bone & Joint Surgery -British Volume 1984; 66( 5): 770-1.
  5. Turner PL. Strapping of curly toes in children. Australian & New Zealand Journal of Surgery 1987; 57( 7): 467-70.
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