Operative Treatment for Fourth Curly Toe Deformity in Adults

Abstract

Background: Curly toe deformity, a relatively common condition, occurs because of contracture of the flexor digitorum longus and flexor digitorum brevis. Numerous operative techniques have been introduced for treatment. However, there are no reports on fixed, longstanding deformity in adults. Methods: Data on 32 toes in 24 consecutive patients treated from 2003 to 2013 who underwent dorsolateral closing wedge-shaped resection arthroplasty for fourth curly toe deformity with a minimum 1-year follow-up were reviewed retrospectively. The mean follow-up period was 49 months. All patients presented preoperatively with a fixed deformity, underriding the adjacent toe. Combined surgeries were performed in 17 cases. Results: Of 32 toes, fixed deformity presented more frequently at the proximal interphalangeal (PIP) joint, and resection at the PIP joint level was performed in 19 cases as opposed to 13 at the distal interphalangeal joint. The mean corrections of varus inclination and shortening were 31 ± 16 degrees and 3.1 ± 2.1 mm, respectively. American Orthopaedic Foot & Ankle Society scores significantly improved from 50 ± 2 preoperatively to 89 ± 8 at the final follow-up. There was 1 case of recurrence, floating toe deformity following pin tract infection in 1 case, and floating toe deformity without infection in 1 case. Conclusion: We introduced dorsolateral closing wedge-shaped resection arthroplasty as a simple, effective, and powerful option for treating fixed, longstanding fourth curly toe deformity in adults. Level of Evidence: Level IV, retrospective case series.