Curly Toes

FigureA 17-month-old boy was brought for evaluation of bilateral foot pain of 3 weeks' duration. He had been born with curly toes-medial curving of the third, fourth, and fifth toes bilaterally. The mother reported that the overlapping of the third toe by the second toe had developed when the infant was about 6 months old and had progressively worsened.

The infant's father and sister had similar toe deformities. Radiographs of the feet revealed no bone abnormalities. The patient was referred to a pediatric orthopedist to reassure the mother.

Curly toes are common in infancy.¹ The medial deviation of the involved toes with overlap by the adjacent normal toe is caused by contracture of the flexor digitorum longus associated with flexion of the metatarsophalangeal and interphalangeal joints. The fourth and fifth toes are most commonly involved.²

This deformity rarely causes symptoms. Most cases resolve over time without treatment. Active treatment, such as stretching, taping, or splinting, has not been shown to affect outcome.³

In the case of chronic toe pain or apposing skin irritation, simple flexor digitorum longus tenotomy at the distal interphalangeal joint has produced good results.⁴

Parental reassurance that the deformity is usually of no clinical consequence is the most important treatment. In some cases, referral to a pediatric orthopedist may be warranted.

References:

• Staheli LT. Fundamentals of Pediatric Orthopedics. New York: Raven Press; 1992.
  

• Kliegman RM, Behrman RE, Jensen HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Saunders; 2007:2782.
  

• Sweetnam R. Congenital curly toes; an investigation into the value of treatment. Lancet. 1958;2:398-400.
  

• Ross ER, Menelaus MB. Open flexor tenotomy for hammer toes and curly toes in childhood. J Bone Joint Surg Br. 1984;66:770-771.