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Updated: Jun 15 2021

Congenital Curly Toe

4.4

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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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