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Curly Toes and Overlapping Toes

- Overlapping Toes:
    - involves an dorsal-adduction deformity of the 5th toe;
          - other components of the deformity include external rotation of the digit, contracture of the EDL tendon;
          - in some cases there may be dislocation of the MTP joint;
    - often the deformity is familial and bilateral;
    - clinical findings:
          - the deformity is asymptomatic, but it can cause difficulty with shoe wear and pain over the dorsum of the toe;
          - a dorsal callus is commonl;
          - in some cases, there will be an associated bunionette;
    - DuVries Correction:
          - may use lateral incision from osteotomy or may make second incision in 4th interspace;
          - release the EDL, dorsal joint capsule, and medial collateral ligament;
    - Butler's Surgical Correction:
          - create a dorsal racket incision over the little digit, centered over the EDL tendon;
          - this allow the toe to be derotated;
          - a second "handle" incision is made on the plantar aspect of the original wound, which is brought laterally and proximally;
                 - this incision allows the toe can now be moved laterally and plantarly;
          - release the contracted extensor tendon and the dorsal capsule;
          - in some cases, the plantar capsule will have to be released through the dorsal capsule;
          - for a good surgical result, the toe must passively lie in a corrected position;
                 - forced correction may place tension on the digital vessels;
                 - if residual deformity is present, more capsule needs to be excised;
          - skin sutures can help keep the toe in a derotated position;
          - in the report by Thordarson, et al, the auhtors report on 3 patients treated with a simpler procedure involving metatarsal phalangeal capsular release dorsally and medially, oblique lengthening of the extensor tendon, and Z-plasty of the skin;
                 - ref: Congenital crossover fifth toe correction with soft tissue release and cutaneous Z-plasty.

- Curly Toes:
    - involves malrotation of one or more toes along w/ digit flexion deformity;
          - in contrast, hammer toes are generally not mal-rotated;
    - may be due to contracture of FDL and FDB;
    - common disorder in children
    - look for symmetric deformity in the opposite foot;
    - treatment:
          - involves FDL tenotomy at age 3-4 years;
          - with more severe deformity consider Girdlestone Taylor Procedure

- References:

Butler arthroplasty for correction of the adducted fifth toe: a retrospective study of 36 operations between 1968 and 1982.

Butler's operation for congenital overriding of the fifth toe. Retrospective 1-7-year study of 23 cases.

Surgical syndactylia of the toes. Kelikian H, et al. Clin Orthop Rel Res. 1961;19:208.

Surgery for curly toe deformity: double-blind, randomised, prospective trial.

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