Pediatric Congenital Curly Toes Review

Dec 17, 2024

Congenital Curly Toes in the Pediatric Population: A Comprehensive Review

Overview

  • Congenital Curly Toe (CCT): Also known as varus or underlapping toe.
  • Prevalence: Affects 2% to 3% of the population.
  • Deformity: Involves flexion and varus deformities of the interphalangeal joints, often in the lateral three toes.
  • Causes: Undetermined, possibly due to fetal positioning in utero or muscle contracture.
  • Symptoms: Mostly asymptomatic but can cause pain or appearance concerns.

Diagnosis and Treatment

  • Diagnosis: Visual grading based on toe overlap.
  • Treatment:
    • Non-severe cases: Taping or strapping.
    • Severe cases: Flexor tenotomy (FT) or tendon transfer (TT).
    • Spontaneous resolution occurs in 25% to 50% of cases.
  • Study Purpose: Evaluate CCT presentation, evaluation, treatment, outcomes, and develop a management algorithm.

Methods

Search Strategy

  • Database: PubMed.
  • Keywords: Pediatric, congenital, child, curly toe, varus toe, underlapping toe.
  • Articles for Screening: 180.

Study Selection

  • Excluded non-English, adult-only, cadaveric, and certain types of studies.
  • Included: 9 articles discussing treatment and outcomes.

Data Extraction

  • Data included number of patients, number of toes affected, demographics, presentation, treatment, and outcomes.

Results

Search Results

  • Articles Reviewed: 18 full-text, 9 met criteria for inclusion.

Study Characteristics

  • Studies: Large-cohort reviews, systematic reviews, prospective studies.
  • Patients: 346 children ≤18 years with CCTs.

Clinical Presentation

  • Mean Age: 7.25 years.
  • Affected Toe: Fourth toe most common.
  • Symptoms: Visual deformity, pain, nail bed deformity.

Evaluation

  • Hamer Grading Scale: Used to classify severity.
  • Imaging: Some studies used radiographs for further classification.

Treatment Options

Nonsurgical

  • Observation, manipulation, bracing, and taping.
  • Used for mild to moderate cases.

Surgical

  • FT and TT used for grades 2 and 3.
  • FT preferred over TT due to better outcomes.

Outcomes

  • Conservative: 62.5% improved or cured; 37.5% unchanged or worsened.
  • Surgical: 84% improved or resolved.

Management Algorithm

  • Based on the existing literature for presentation, evaluation, treatments, and outcomes.
  • Conservative First-Line: Observation and stretching for up to a year.
  • Surgical Consideration: Severe or symptomatic cases after conservative attempts.

Discussion

Presentation and Workup

  • Most Affected: Fourth toe, bilateral presentation common.

Treatment Options

  • Conservative: Limited effectiveness, better in younger children.
  • Surgical: Preferred for severe cases, especially in older children.

Outcomes and Follow-up

  • Measurement Scales: Biyani grading scale, AOFAS score.
  • Follow-up: Minimum of 3 years recommended.

Limitations

  • Limited literature on pediatric CCTs, small sample sizes.
  • Variability in data collection and outcome measures.

Conclusion

  • This review provides a comprehensive framework for management of pediatric CCTs, offering guidance for clinical decision making.

References

  1. Smith WG, et al (2007)
  2. Schrier JCM, et al (2009)
  3. Sweetnam R (1958)
  4. Brucato MP, et al (2022)
  5. Pollard JP, et al (1975) ...