A Retrospective Analysis of Surgical Treatments for Adult Curly Toe

Background: Curly toe deformity (clinocamptodactyly) is a common deformity that can present in more than one toe, most frequently the 4^th and 5^th and is caused by contracture of the flexor digitorum longus and brevis tendons. It can occur in all age groups but most typically early infancy/childhood and middle aged women.

Methods: A review of patients treated for curly toe deformity at Toronto Western Hospital was conducted. Data was collected fom 46 patients over an eleven year period from 2006-2017.

Results: The majority of patients were women (42, mean age 54; SD 11) and a minority were men (4, mean age 58; SD 11). Slightly more deformities were noted in the right foot (17; 37%), while the left was affected in 15 patients (33%) and 14 patients bilaterally (30%). In childhood, percutaneous flexor tenotomy is the procedure of choice. In adults when the deformity was flexible and dynamic, a Girdlestone tendon transfer was performed (8 cases; 17%). In the presence of a fixed flexion deformity proximal interphalangeal joint (PIP) arthroplasty was used (17 cases; 37%). Fifty percent of patients (23) were recommended for one or the other procedure but declined.

Conclusions: Many surgical options are available to treat adult curly toe as conservative methods do not always provide permanent relief. Patients in this review who underwent surgery, overall, experienced good clinical outcomes. Adverse events included mild site infection (4 patients, 9%), keloid formation (2 patients, 4%) and one patient required IV antibiotics for a post operative staph infection. Five patients required removal of absorbable sutures 2-4 months post-operatively.