Pediatric Toe Deformities
Key Points
- Common presenting complaint in pediatric clinics
- Most are flexible in early stages
- Can be congenital or acquired
- May indicate underlying neurological conditions
- Early intervention prevents fixed deformities
Classification Overview
- Based on Direction:
- Varus deformities
- Valgus deformities
- Flexion deformities
- Extension deformities
- Based on Flexibility:
- Flexible (reducible)
- Semi-rigid
- Rigid (fixed)
- Based on Timing:
- Congenital
- Developmental
- Acquired
Common Toe Deformities
1. Hallux Valgus
- Characteristics:
- First toe deviation laterally
- Medial bunion formation
- Often familial
- Risk Factors:
- Positive family history
- Ligamentous laxity
- Metatarsus primus varus
- Inappropriate footwear
2. Curly Toes
- Features:
- Flexion-supination deformity
- Usually affects 3rd-5th toes
- Often bilateral
- Familial tendency
- Characteristics:
- Present at birth
- May be asymptomatic
- Can cause shoe fitting issues
3. Underlapping/Overlapping Toes
- Common Types:
- Fifth toe overlapping
- Second toe overlapping
- Congenital clasped fifth toe
- Associated Findings:
- Skin irritation
- Callus formation
- Nail deformities
4. Polydactyly
- Types:
- Preaxial (medial)
- Postaxial (lateral)
- Central
- Associated Conditions:
- Ellis-van Creveld syndrome
- Trisomy 13
- Smith-Lemli-Opitz syndrome
5. Syndactyly
- Classification:
- Complete vs Incomplete
- Simple vs Complex
- Complicated vs Uncomplicated
- Associated Syndromes:
- Apert syndrome
- Poland syndrome
- Down syndrome
Assessment
Clinical Evaluation
- History:
- Age of onset
- Family history
- Previous treatments
- Impact on activities
- Associated symptoms
- Physical Examination:
- Standing assessment
- Gait analysis
- Flexibility testing
- Neurovascular status
- Associated deformities
Imaging Studies
- Radiographs:
- Weight-bearing AP/Lateral
- Oblique views
- Sesamoid views
- Key Measurements:
- Hallux valgus angle
- Intermetatarsal angle
- DMAA (Distal Metatarsal Articular Angle)
Management Approach
Conservative Treatment
- General Measures:
- Appropriate footwear
- Toe spacers
- Stretching exercises
- Night splints
- Specific Methods:
- Taping techniques
- Silicon orthoses
- Custom insoles
- Padding
Surgical Management
- Hallux Valgus:
- Soft tissue procedures
- Osteotomies:
- Akin
- Chevron
- Ludloff
- Curly Toes:
- Flexor tenotomy
- Soft tissue release
- Digital arthroplasty
- Polydactyly:
- Simple excision
- Reconstruction
- Ray resection
- Syndactyly:
- Separation
- Skin grafting
- Local flaps
Postoperative Care
- Early Phase (0-2 weeks):
- Wound care
- Elevation
- Pain management
- Intermediate Phase (2-6 weeks):
- Gradual mobilization
- Toe exercises
- Scar management
- Late Phase (6+ weeks):
- Return to normal shoes
- Activity progression
- Prevention of recurrence
