50: Flexor Tenotomy for Congenital Curly Toe

Flexor Tenotomy for Congenital Curly Toe

Indications

Persistence of the congenital curly toe deformity later in childhood.

Symptoms, including skin breakdown, painful callosities, and shoewear issues, which are not amenable to nonoperative care.

Conservative measures, including taping and splinting, are generally not successful for symptomatic curly toe after age 6 years.

Pitfalls

• This is a common deformity; most cases do not need treatment and will resolve by age 6 years or will be asymptomatic.

• Be confident in the diagnosis: curly toe is due to a congenital shortening of the long flexor tendon.

Examination/Imaging

Curly toe is characterized by flexion at the proximal interphalangeal joint, varus deviation, and external rotation usually of the third or fourth toe. Flexing of the metatarsophalangeal joint should allow the distal deformities to be passively corrected.

The curly toe is usually the third or fourth toe (Fig. 1), which tucks under (and appears to lift up) the more medial toe.

FIGURE 1

Treatment Options

• Flexor to extensor tendon transfer (originally described by Girdlestone) is an alternate procedure for correction of curly toe, but in a randomized double-blind prospective trial was found to have no difference in outcome. Others have found flexor-to-extensor transfer to have a higher morbidity than flexor tenotomy, including higher rates of postoperative stiffness.

Surgical Anatomy

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Tags: Operative Techniques Pediatric Orthopaedic Surgery

Jun 7, 2016 | Posted by admin in ORTHOPEDIC | Comments Off

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