Congenital Curly Toes in the Pediatric Population: A Management Algorithm and Systematic Review

Abstract

Purpose: This study aims to formulate a systematic management algorithm for pediatric congenital curly toes (CCTs), addressing the lack of standardized guidelines. By synthesizing the existing literature, the study evaluates CCT presentation, evaluation, treatment options, and outcomes. Methods: A systematic review on PubMed identified nine articles, involving 346 patients younger than 18 years with CCTs. Data extraction included presentation, evaluation, treatment modalities, and outcomes. Results: The analysis revealed that pediatric CCTs predominantly present in younger children. Clinical presentation often involves family concerns or referrals from primary care physicians, emphasizing the aesthetic nature of the condition. The most affected toes are the fourth (43.8%) and fifth (25%). Evaluation methods vary, with the Hamer grading scale and Satake imaging system being prominent. Nonsurgical treatments, including taping and observation, are favored for mild cases (grade 0 to 1), whereas surgical interventions, such as tendon transfer and flexor tenotomy, are reserved for moderate to severe cases (grade 2 to 3). Results indicate that conservative treatments yield varied outcomes, with surgical interventions demonstrating more favorable and permanent results, especially for Grades 2 to 3 deformities. Conclusion: This study proposes a stepwise management algorithm integrating clinical presentation, severity grading, and age-specific considerations for pediatric CCTs. The aim is to guide both nonsurgical and surgical interventions, enhancing clinical decision making for improved patient outcomes. Further research is recommended for algorithm validation.