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
QUESTIONS 1 of 2 1 2 Previous Next (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: A B Type & Select Correct Answer 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 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07PE.97) What is the preferred treatment of a symptomatic curly toe deformity in a 6-year-old child? QID: 6157 Type & Select Correct Answer 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 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic