Updated: 11/8/2016

Congenital Curly Toe

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Topic
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Questions
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Evidence
3 3
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Introduction
  • Common congenital deformity
    • 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
  • True incidence and natural history unknown
    • usually involves lateral three toes
    • usually bilateral

 

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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Average 4.4 of 14 Ratings

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? Tested Concept

QID: 3039
FIGURES:
1

Flexor digitorum longus (FDL) transfer to the extensor side

2%

(71/3442)

2

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

3%

(110/3442)

3

Toe strapping with tape

10%

(352/3442)

4

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

5%

(172/3442)

5

Observation

79%

(2717/3442)

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? Tested Concept

QID: 6157
1

Observation

18%

(27/146)

2

Tape the toe to the adjacent toes for 8 weeks

20%

(29/146)

3

Tenotomy of the flexor tendons

57%

(83/146)

4

Transfer of the flexor tendons to the extensor mechanism

4%

(6/146)

5

Arthrodesis of the proximal interphalangeal joint

1%

(1/146)

N/A E

Select Answer to see Preferred Response

Evidences (4)
Topic COMMENTS (3)
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