Curly toe or congenital curly toe (clinodactyly)

What is curly toe?

Curly toe occurs when a toe appears bent and turns towards the big toe and may curl under the toes next to them. It is a common condition that usually affects both feet and most often affects the third and fourth toes. The toes next to the curly toe may overlap it. The tightening of the flexor digitorum longus (FDL) or flexor digitorum brevis (FDB) tendons is the most common cause of curly toe.

Most cases get better on their own without treatment as the child grows and develops. Curly toes rarely affect the ability of a child to walk or participate in activities. They also will not impact a child meeting their motor milestones. Only in rare cases is treatment needed.

What are the signs and symptoms of curly toes?

Curly toes do not usually cause pain. However, as some children get older, they may have:

• discomfort when wearing shoes
• callouses
• blisters
• nail deformity

How are curly toes diagnosed?

A health-care provider will look at the toe’s position and movement. X-rays of the foot are not needed.

How are curly toes treated?

Curly toes do not usually cause symptoms, so just watching is recommended. Initial treatments may include:

• wearing wider shoe widths

Taping or toe strapping is not recommended. There is no strong evidence for stretching exercises of the toe.

Curly toe often corrects itself by 6 years of age without surgical treatment. Surgical treatment is rare but may be considered if:

• there is an associated deformity of the toes that prevents shoes from being worn or causes skin and/or nail issues such as:
  • pain and callouses on the top and bottom of the curly toe and/or the toe next to it
  • pain associated with ingrowth or irritation of the nail on the curly toe
• the child is older than 6 years of age

If surgical treatment is needed, then the tendon is cut. This will improve the curling down and some of the overlapping of the toes, but not the sideways curvature. Fixing the curvature of the toe is not indicated in children. Even with surgery there is always a risk the curly toe will recur.

If there are concerns regarding the nail, this is treated by a chiropodist in the community.

At SickKids

SickKids does not accept referrals for children with curly toe under 6 years of age. Curly toe typically improves or resolves by 6 years of age. If the child is over 6 years of age and the curly toe has not resolved and is symptomatic, then the child can be referred at that time with photos attached to the referral.

References

Mosca, V. (2014). Principles and Management of Pediatric Foot and Ankle Deformities and Malformations (1st ed.). Wolters Kluwer Health.

Pediatric Orthopaedic Society of North America. (n.d.). Curly Toe. https://posna.org/physician-education/study-guide/curly-toe

Hughes, M. (2021, June 15). Congenital Curly Toe. Orthobullets. https://www.orthobullets.com/pediatrics/4081/congenital-curly-toe