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Review Question - QID 3039

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QID 3039 (Type "3039" in App Search)
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?
  • A
  • B

Flexor digitorum longus (FDL) transfer to the extensor side

2%

81/4003

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

3%

136/4003

Toe strapping with tape

10%

402/4003

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

5%

202/4003

Observation

79%

3159/4003

  • A
  • B

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Curly toe is a common congenital deformity characterized by flexion and varus deformity of the interphalangeal joints. Third and fourth toes are frequently affected and most patients don't have symptoms.

Sweetnam stated that treatment was unnecessary because of the lack of symptoms and self-corrective nature. He indicated that 25% of his patients showed spontaneous improvement, even if untreated. He stated observation had the same success rate as treatment with toe strapping and was less painful.

Answers 1, 2, and 4 are all surgical techniques discussed but are not the gold standard for initial treatment. Surgery is considered if symptoms are present (pain, difficulty with shoe wear, nail problems) after age 3 years.

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