Definition
Under-riding toe
- toe lies beneath adjacent toe
- congenital deformity
Pathology
Due to tight FDL & FDB
- capsule initially normal
- becomes constricted with time
Clinical
Usually 3rd toe
- flexed, ER, medially deviated
Deformity accentuated when standing
Ankle dorsiflexion
- increases deformity
May present with
- cosmetic concerns
- callus & blister formation
Management
Non-operative
Most don't require treatment
- most non symptomatic
- 25% improve spontaneously
Operative
If symptoms judged sufficient
- wait till > 4 years old
Options
Flexible deformity 4 - 12 year old
- flexor tenotomy thru plantar skin
- just divide FDL
Fixed deformity > 12 years old
- resection / arthrodesis of IPJ
Case scenario
- 2 year old with curly toes
- nil other abnormality
- vast majority will improve
- give stretches for parents to do
- only if continual problem, do FDL release