Curly toes

Congenital curly toes are a common condition that tend to affect the 3^rd, 4^th and 5^th toes of one or both feet, usually present at birth but can become more noticeable when a child starts walking.

Curly toes are a normal variant and generally don’t require treatment unless they are symptomatic. They generally do not cause any problems. Occasionally the tendons can become tight and pull the tip of the toe underneath the next toe and towards the sole of the foot. Children complain of rubbing or pain and may have problems with finding suitable shoes that fit properly.

Action: Key Assessment points

• Check passive range of motion of the toes, will they fully correct to a neutral position and is there any tightness in the toe flexor tendons?

• Check for generalised muscle tightness particularly in toe flexor tendons and calf complex (silfverskiold test
• Check for ‘clawing’ toes or cavus feet

Action: Referral not indicated

• Overriding toes are flexible/correctable

• Advise on silicone toe spacers and foot wear with a wide toe box
• Reassure the parent/guardian that curly toes are entirely normal and give advice leaflet titled curly toes if indicated APCP advice leaflet leaflet Choosing Footwear for Children

Action: Refer to Paediatric Physiotherapy

• There is associated muscle tightness and/or weakness that is exacerbating the problem

Refer to Paediatric Orthopaedics

• Refer curly toes that are not passively correctable to a neutral position and causing painful blisters or rubbing, callouses or ingrowing infected toe nails possibly requiring surgical intervention

Refer to Community Paediatrician or Neurologist

• If all of the toes of one or both feet are clawed, resulting in a cavus foot this requires further investigation

Action: Refer to Community Podiatry Service

• If curly toes are significant refer for consideration of toe props/wedges