Curly toes

What is it?

“Curly toe” is the description given to a toe that tends to bend downwards, inwards and often under the neighbouring toe. A child may have one or more affected toes. The middle toe is most commonly affected, but it can affect the fourth or fifth toes.

Why does it happen?

We don’t really know. We know that the flexor tendons of the toe (which are part of the muscles that control the downward bending of the toe) are tight, but we don’t know why this is the case.

What should be done?

Curly toes are very common, and do not have to be treated unless they are causing problems for your child. The affected toe may develop blisters or sores because it is in an unusual position when walking, or it may cause problems by under-riding the neighbouring toe, which can cause rubbing against the top of shoes. Some toes do improve as the child grows, but this depends on the severity of the problem, and usually does not happen after the age of 3-4 years.

There is no role for toe-spacers, or splints. These will not change the way the toe grows, and can often make shoe fitting even more difficult.

The treatment that I offer is the Flexor Tenotomy operation. The purpose of this operation is to stop the affected toe curling underneath or into the neighbouring toe. Toes are not usually completely straight, and the purpose of this operation is NOT to make the toe completely straight.

This is a safe and simple operation performed under a general anaesthetic as a day-stay. It involves making a small cut at the base of the toe on its undersurface. Through this, the flexor tendons are completely cut. The skin incision is then closed with sutures that will absorb themselves. We would operate on all affected toes as a single procedure.

The toe(s) is/are dressed with paraffin gauze, and gauze swabs soaked in antiseptic. The whole foot is then wrapped in bandaging. Your child will be given special sandals that have a raised heel which keeps the front of the foot off the floor, making it easier and less painful to walk.

Our specially trained physiotherapists will assess your child to make sure they do not need special walking aids, and that they are safe to be discharged home.

Ideally, the bandaging should stay on for two weeks, but if it becomes loose after 5 days it does not need to be re-applied.

During the operation, we inject local anaesthetic into the area to relieve pain for a few hours after surgery. Paracetamol and ibuprofen are usually adequate for pain relief after this.

Risks of the operation include infection, bleeding, injury to nerves and blood vessels in the toes, failure to completely correct the deformity and recurrence in the future. Any operation can leave your child worse off than they were before surgery.

We will see your child in the outpatient department for a check-up at 2 weeks and then 6 weeks after surgery.