Curly Toes

What are curly toes?

Curly toes is a common congenital condition (present from birth) in which one or more toes curl downwards and inwards, often tucking beneath the adjacent toe. It most commonly affects the third, fourth, or fifth toes and is frequently bilateral (affecting both feet). The condition is caused by tight flexor tendons on the underside of the toe pulling the toe into a curled position.

How common is it?

Curly toes are among the most common foot problems seen in children. Many cases improve spontaneously in the first few years of life, particularly before walking age. The condition often runs in families.

Does it cause problems?

In the majority of children, curly toes are painless and do not cause functional problems. The main concerns parents report are:

• Difficulty fitting shoes — the curled toe may rub on the toe box of footwear

• Callus or skin irritation where the toe presses against the adjacent toe

• Cosmetic appearance

• In older children, occasional pain or discomfort with prolonged walking or sport

Treatment options

Conservative (non-surgical) management

For most children, no treatment is required in the first instance. The following are recommended:

• Observation — regular review to assess whether the condition is improving, stable, or worsening

• Wide-fitting footwear — shoes with a wide toe box reduce pressure on the curled toe

• Toe spacers or splinting — there is limited evidence that splinting corrects curly toes, but it may reduce discomfort

• Stretching exercises — gentle passive stretching may help in mild cases in young children

Surgery — flexor tenotomy

If surgery is recommended, the standard procedure is a flexor digitorum longus (FDL) tenotomy — a simple release of the tight tendon that is pulling the toe into the curled position.

• General anaesthetic is administered.

• A small stab incision (2-3 mm) is made at the base of the toe on the plantar (sole) surface.

• The tight flexor tendon is divided using a small tenotome (thin blade).

• The toe is straightened and the result confirmed clinically.

• The skin nick is closed with a single stitch or steristrip and dressed.

• The procedure takes approximately 10-15 minutes per toe. Multiple toes can be treated in the same operation.

Benefits of surgery

• Straightens the curled toe permanently in most cases

• Relieves pressure, rubbing, and callus formation

• Improves shoe fitting

• Simple, quick procedure with rapid recovery

Risks and possible complications

• Wound infection — rare with this small incision

• Incomplete correction — the toe may remain slightly curled or re-curl over time

• Recurrence — uncommon after complete tenotomy

• Temporary swelling and bruising of the toe

• Rarely, injury to the digital nerve or blood vessel — risk is very low with this technique

• Anaesthetic risks — discussed by the anaesthetic team

Recovery

Note:When is surgery considered? Most curly toes do not require surgery. Operation is considered only when the toe is causing persistent pain, shoe-fitting difficulties, or skin problems that have not resolved with conservative measures, and when the child is old enough for the procedure (usually over 3-4 years of age).

Timeline

What to expect

Day 0-2

Dressing in place. Elevate foot.

48 hours

Wool and crepe dressing removed at home.

2 weeks

Opsite dressing removed at home. Wound   usually healed.

2-4 weeks

Normal footwear. Full weight-bearing.

Return to school

Usually within a few days in wide   comfortable shoes.

Return to PE / sport

2-4 weeks once comfortable.

Note:When to seek urgent help Increasing redness, swelling, or discharge from the wound beyond the first week The toe appears very pale or blue (circulation concern) Temperature above 38 degrees C

This information is for general guidance only and is not a substitute for a consultation with Mr Wadia. If you are worried about your child, please seek medical advice.