Congenital curly toes

Congenital curly toes is a condition that is present at birth and tends to affect the third, fourth and fifth toes on one or both feet. This information from Great Ormond Street Hospital (GOSH) explains the causes, symptoms and treatments for the condition.

The movement of our toes is controlled by tendons which run from the ankle to the tips of the toes. Congenital curly toes develop because these tendons are too tight and pull the toe under the next toe, curling it towards the underside of the foot.

Occasionally, congenital curly toes are caused by a problem with the bones rather than the tendons. These need to be corrected differently  this information is not included here.

What are the symptoms of congenital curly toes?

The main symptom is the visible curling of one or more toes underneath the next toe(s). This may not cause any other symptoms but you might notice that your child is developing areas of hard skin on the sole of the foot, having difficulty with wearing some styles of shoes or finding suitable shoes that fit properly.

What causes them?

Congenital curly toes are caused by the tendon running underneath the toe being too tight and pulling the tip of the toe underneath the next toe and towards the sole. We do not know exactly what causes this tightening, but it has been noted that the condition can affect several generations, which implies that it is passed on from parent to child (inherited).

How common are congenital curly toes?

We do not have exact figures, but we know that it is one of the more common foot problems in childhood.

How can it be treated?

While your child is under a general anaesthetic, the surgeon makes a small cut underneath the affected toe, near to the ball of the foot. He or she releases the tendon so improve the position of the toe. This is repeated for each affected toe. The cut is closed using dissolvable stitches, which will not need to be removed and covered with a dressing. Towards the end of the operation, the surgeon will inject some local anaesthetic. The procedure takes around 20 minutes for each toe.

Are there any risks?

As with all surgery, there is a risk of bleeding but the surgeon uses a tourniquet to reduce blood flow to the operation site, so there is rarely any serious blood loss. There is a risk of infection as the skin is opened, but the child will be given antibiotics to reduce the risk of this. If an infection does occur, it is usually minor and easily treated with a course of antibiotics. There is a very small risk of nerve injury or of loss of the blood supply to the digit but this is very rare with experienced surgeons. There is a chance that the tendon could tighten again as the child grows older and his or her feet grow. This would cause the toes to start curling under again but is easily corrected with a repeat of the operation above.

What happens after the operation?

Once the child has recovered fully from the anaesthetic, he or she will be allowed to go home. For most children, this is usually four hours after the operation.

When you get home

  • The operation is not a particularly painful one, so the child should only need a dose or two of pain relief such as paracetamol once you return home.
  • The dressing should stay in place until the clinic appointment. The child will go to an appointment at the dressing clinic one to two weeks after the operation so that we can check the operation site is healing well.
  • Try to keep the child’s foot clean and dry until the operation site starts to heal. The rest of the foot can be cleaned gently but the operation site itself should not get wet.
  • Avoid play with sand, soil, mud or water.
  • After the dressing has been removed, the child should continue to wear shoes, especially out of doors, but they should allow plenty of toe movement to help the area heal. Open-toed shoes are not recommended due to the risk of infection.
  • The stitches will gradually dissolve but try to stop the child picking at them or any scabs that form in the first few days after the operation.
  • As long as the child is generally well, he or she can go back to nursery or school two to three days after the operation.

You should call us if:

  • The child has a temperature of more than 37.5°C
  • The can see swelling or redness near the operation site or there is any oozing
  • The child is in a lot of pain and pain relief does not seem to help.
Compiled by: 
The Congenital Hand Anomaly team in collaboration with the Child and Family Information Group
Last review date: 
May 2014