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Congenital Curly Toe

Topic updated on 01/30/14 8:00pm
Introduction
  • Common congenital deformity
    • flexion and varus deformity of the interphalangeal joints
    • contracture of the flexor digitorum longus (FDL) or flexor digitorum brevis (FDB) is the most common cause
  • True incidence and natural history unknown
    • usually involves lateral three toes
    • usually bilateral

 

Presentation
  • Symptoms
    • usually asymptomatic
Imaging
  • Radiographs
    • not indicated
Treatment
  • Nonoperative
    • observation
      • indications
        • usually asymptomatic and requires no treatment  
      • toe strapping not found to be beneficial
  • Operative
    • surgical soft tissue release
      • indications
        • FDL release reserved for severe toe deformity or nail bed deformity in children typically > 3 years old
      • outcomes
        • 85-90% effective
Techniques
  • Surgical soft tissue release
    • open tenotomy of both slips of the flexor digitorum brevis (FDB) and FDL tendon
    • open tenotomy of one slip of the flexor digitorum brevis (FDB) tendon only
    • flexor digitorum longus (FDL) transfer to the extensor hood

 

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Qbank (1 Questions)

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(OBQ09.226) An 8 month-old girl is brought in to your clinic by her mother for a second opinion of her daughter's congenital deformity seen in Figures A and B. The mother reports that the first surgeon recommended an open tenotomy of one slip of the flexor digitorum brevis (FDB) tendon, dissection of the collateral ligament and the volar plate, and reconstruction of the plantar skin defect. What is your recommendation to the patient's mother for treatment of the congenital curly toe? Topic Review Topic
FIGURES: A   B        

1. Flexor digitorum longus (FDL) transfer to the extensor side
2. Open tenotomy of one slip of the flexor digitorum brevis (FDB) tendon only
3. Toe strapping with tape
4. Open tenotomy of both slips of the flexor digitorum brevis (FDB) and FDL tendon
5. Observation

PREFERRED RESPONSE ▶




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