What is Curly Toe Syndrome?

Curly Toe Syndrome, also known as Digiti Quinti Varus, is a condition that involves the curling of the toe bones in the foot. It is most commonly present in the 3rd, 4th or, 5th toe and may affect both feet.

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Overview

Curly toe syndrome can be congenital or acquired, resulting in the affected toe crossing over or under its neighbouring toe or assuming a hook-like position. As children start walking, this condition can become more noticeable, evolving from a flexible deformity to a more rigid one.

Conditions similar to curly toe syndrome

Curly toes may also be mistaken for other common forms of crooked toes such as:

  • Hammer toe – Any toe with an abnormal bend at the middle joint, resembling a hammer. They commonly occur in the 2nd or 3rd toe of one or both feet.
  • Mallet toe – Similar to hammer toes, mallet toes bend abnormally, but at the 1st joint of the toe closest to the nail.
  • Claw toe – This involves the bending of the toes at both the 1st and 2nd joint. These can often lead to the development of painful corns and calluses.
  • Overlapping toe – Any toe that overlaps over the adjacent toe in one or both feet. This affects the little toe in particular.

Causes of Curly Toe Syndrome

The cause of this deformity is due to the contracture or shortening of the muscles within the foot, specifically the flexor digitorum longus and brevis muscles. These muscles control the movement of our toes and any imbalance of this muscle can result in deformity. The shortening of these muscles is usually due to the gripping of the toes on the floor or wearing certain footwear. The toes grip down to stabilise the foot, as a result, the small joints of the toe are put under excess strain and begin to deform.

Curly toes are often asymptomatic but in the long term, it can cause problems such as having limited footwear choices. This is due to the need for a wider toe box to accommodate this foot deformity. If ill-fitting footwear like tight-fitting shoes is worn, excess pressure on the toe may lead to callus, corns, or blisters developing. If the situation deteriorates, the integrity of the nail may be affected. This eventually can lead to deformity of the nail and an increased risk of fungal or other infections developing.

How Is Curly Toe Syndrome Managed?

Curly toes in children can be effectively managed through conservative methods, including the use of customised insoles or paediatric ankle-foot orthotics to achieve proper toe realignment. When coupled with appropriate footwear, these interventions help stabilise and support a child’s growing foot, reducing the risk of developing rigid and often painful toe deformities like bunions.

Adults with curly toes often neglect podiatric care for the underlying conditions and focus on the secondary symptoms, such as bursae, pain, fungal infections, nail trauma, and tailor’s bunions. While these secondary symptoms can be treated with various in-clinic remedies, addressing curly toe as the root cause is crucial to preventing their recurrence.

The management approach for curly-toe syndrome depends on the severity of the deformity. In mild cases, the following solutions may be considered:

  • Wearing shoes with a wide toe box
  • Stretching exercises for the toes
  • Customised foot orthotics prescribed by a Podiatrist

In more severe cases, surgery may be considered, typically recommended for adults, as children's bones are still growing and may correct the deformity naturally. If there are concerns about curly toe syndrome, seeking advice from a podiatrist is important for proper guidance.

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Common Symptoms

Flattened
Thickened
Split toenails
Painful corns or blisters from pressure
A limitation in footwear choices
Pain or discomfort during or after physical activities
Frequent falling or tripping
Gait imbalances

How It Looks Like

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Related Conditions

FAQs

Why Does My Child Have Toe Pain?

Toe pain can arise from many causes such as, injuries, infectious diseases, or as a by-product of other disorders that affect the body. Toe pain that presents at the top of the toe joints is often caused by biomechanical issues or muscle imbalance. Other forms of toe pain, such as those caused by underlying disorders or conditions, run the risk of becoming progressively worse. A professional diagnosis and podiatric intervention must be sought out to avoid complications.

What Can I Do If My Child Has A Curly Toe/Hammer Toe/Claw toe/Mallet Toe?

Appropriate footwear such as shoes with a wide and deep toe box can reduce excess pressure at the affected toe joints. See a podiatrist promptly for solutions such as a pair of customised insoles. Insoles can help prevent the deformity from worsening and offload weight from the affected areas. Your child’s foot structure is still malleable, and with early intervention it can prevent the progression and permanence of toe deformities.

How Do I Prevent My Child From Developing Curly Toes?

Acquired curly toes can be prevented in your child by reducing the use of unsupportive footwear such as slippers. Regular stretching exercises can also reduce tightening in the toe muscles.

What Type Of Footwear Can Accommodate Curly Toes?

A pair of wide shoes with a deep square-shaped toe box can accommodate for toe deformities (curly toes/hammer toes/claw toes/mallet toes).

Will Curly Toes Affect My Child’s Activity Level?

It depends on the type of activities and footwear your child will be exposed to. Curly toes will only affect your child’s activity level if they are required to wear tight footwear such as soccer boots or ballet shoes which can compress and irritate the deformity, making it uncomfortable to move.

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