|
Year |
2002 |
|---|---|
|
Question Number |
101 |
|
Category |
Pediatric Orthopaedics |
Question
A 6 year-old girl has fourth toes that overlap the third toes bilaterally since birth. Her parents report difficulty in fitting shoes. Examination reveals redness and tenderness over the fourth toes. Management should consist of :
1. Observation
2. Taping the toes
3. Extensor release of the fourth toes.
4. Flexor tenotomies of the third toes
5. Plantar flexion osteotomy of the fourth proximal phalanges
Figures
Answer (click for answer)
Preferred Answer: 4
The description is consistent with the diagnosis of curly toes involving left and right third toe. It involves malrotation of one or more toes along w/ digit flexion deformity. Curly (varus or underriding) toes have a combination of flexion deformity, varus deviation and lateral rotation of one or both interphalangeal joints. In childhood there is seldom significant fixed deformity of the affected joints in either of these conditions. If the clinician flexes the metatarsophalangeal joint of the affected digit, then the deformities of the terminal joints can be passively corrected. This physical sign indicates that the resting length of the flexor tendons is unduly short and that tenotomy of the long flexor tendon and of the two portions of the short flexor will correct both hammertoes and curly toes. Open tenotomy is preferred as on of the three flexor tendons may elude division if closed tenotomy is performed.
Reference: Ross ER, Menelaus MB: Open flexor tenotomy for hammertoe and curly toes in childhood. J Bone Joint Surgery Br 1984;66:770-771