Updated: 6/15/2021

Congenital Curly Toe

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  • 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

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Flashcards (2)
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Questions (2)

(OBQ09.226) An 8 month-old girl is brought in to your clinic by her mother for a second opinion of her daughter's congenital deformity seen in Figures A and B. The mother reports that the first surgeon recommended an open tenotomy of one slip of the flexor digitorum brevis (FDB) tendon, dissection of the collateral ligament and the volar plate, and reconstruction of the plantar skin defect. What is your recommendation to the patient's mother for treatment of the congenital curly toe?

QID: 3039
FIGURES:
1

Flexor digitorum longus (FDL) transfer to the extensor side

2%

(70/3589)

2

Open tenotomy of one slip of the flexor digitorum brevis (FDB) tendon only

3%

(117/3589)

3

Toe strapping with tape

10%

(372/3589)

4

Open tenotomy of both slips of the flexor digitorum brevis (FDB) and FDL tendon

5%

(181/3589)

5

Observation

79%

(2828/3589)

L 2 C

Select Answer to see Preferred Response

(SAE07PE.97) What is the preferred treatment of a symptomatic curly toe deformity in a 6-year-old child?

QID: 6157
1

Observation

19%

(48/252)

2

Tape the toe to the adjacent toes for 8 weeks

21%

(53/252)

3

Tenotomy of the flexor tendons

54%

(135/252)

4

Transfer of the flexor tendons to the extensor mechanism

6%

(14/252)

5

Arthrodesis of the proximal interphalangeal joint

0%

(1/252)

N/A E

Select Answer to see Preferred Response

Evidence (4)
EXPERT COMMENTS (3)
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