Overview
What are curly toes?
Curly toes describe a flexion and deviation of the toe, usually the 3rd or 4th toe. It is known to be caused by tight flexor tendons. This is more common in children that have a family history of this condition.
When a child is standing, you may see the toes curling slightly. Often it is the third and fourth toes and it may be that there is even some overlapping where a toe crosses over or is pushed slightly under the others by another curling next to it.
Symptoms
The most obvious symptom is the visible curling of the toes – while this may be quite worrying, parents should be reassured that there are not likely to be any severe or worrying symptoms.
They may cause pressure symptoms from shoe wear later in life such as blisters or calluses.
Treatment
Investigations
In order to evaluate and manage curly toes, X-rays are often not needed and instead, simple assessments can be carried out.
Watch and wait
For some children, no treatment will be required. Around one in five children will not need any kind of treatment before the age of 6. Given this, I usually advise that no treatment is needed before the age of 4.
Furthermore, shoes that provide extra space across the toes may be helpful.
Taping
Taping can be done and this may improve the positioning, but this is often temporary and the curling may return if or when the taping is stopped.
Surgery
Where the curling does not resolve itself naturally by the time a child turns 4, surgery may be required. This is carried out under a general anaesthetic.
The surgery involves cutting the flexor tendons to release the tendon and improve the position of the affected toes. Dissolvable stitches are used to close the cut, which avoids the need to come back in to remove them.
The procedure is relatively short, at around 20 minutes for each toe. Furthermore, local anaesthetic is injected into each toe towards the end of the operation, to reduce the pain that will be felt when the child wakes up.
Helpful resources
A patient's story
Ellis
"I wanted to thank you for not only your work on Ellis' elbow, but your positive attitude and swift treatment. Everything healed well and Ellis is now back at the gym and will start competing in CrossFit - I don't think he would be doing this without your help."
Ian, Dad to Ellis
