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