summary Congenital Curly Toe is a common congenital deformity caused by contracture of the flexor digitorum longus or flexor digitorum brevis that presents with resting flexion of a toe. Diagnosis is made clinically with presence of a flexion and varus deformity of the interphalangeal joints, most commonly affecting one of the lateral 3 toes. Treatment is observation as the condition is usually asymptomatic. Surgical soft tissue release is indicated in the presence of a severe toe or nail bed deformity in children typically greater than 3 years old. Epidemiology Incidence and natural history unknown Anatomic location usually involves lateral three toes usually bilateral Etiology Mechanism flexion and varus deformity of the interphalangeal joints contracture of the flexor digitorum longus (FDL) or flexor digitorum brevis (FDB) is the most common cause Presentation Symptoms usually asymptomatic Imaging Radiographs not indicated Treatment Nonoperative observation indications usually asymptomatic and requires no treatment toe strapping not found to be beneficial Operative soft tissue release e.g. flexor tenotomy indications FDL release reserved for severe toe deformity or nail bed deformity in children typically > 3 years old outcomes 85-90% effective flexor tenotomy is as effective as flexor tendon transfer Techniques Surgical soft tissue release open tenotomy of both slips of the flexor digitorum brevis (FDB) and FDL tendon open tenotomy of one slip of the flexor digitorum brevis (FDB) tendon only flexor digitorum longus (FDL) transfer to the extensor hood