Monday, June 12, 2017

Let's talk Curly Toes

It may be a bit of a shock to learn it is more common to have buckled toes than it is to have straight ones. Straight toes in children are quite rare. Only in a very few cases is there any real concerns, and usually in such cases the child will have already report other painful symptoms and or an unstable gait or lack of normal growth development.

Toe deformities are of two types, congenital and acquired. Congenital deformities are inherited which is governed by genetics. Two common congenital deformities affecting the smaller toes are webbed feet (syndactylism); and extra toes or polydactylism. Currently the in the Guinness Book of Records 2016, the largest number of toes on one foot, is seven. Neither syndactylism or polydactylism present real problems nor it is usual to remove the extra toes early in life.

During the Middle Ages when removing a toe was life threatening broad shoes (Bear's Paw) became vogue. Many believe it was because the King of Spain had polydactilism fashions changed to accommodate. In the Connan Doyle's, The Hound of the Baskervilles, the solution Homes seeks involves congenital polydactilism.

Acquired deformities describe a process which usually involves post-traumatic repair. So a major cause of toe deformities is either one off trauma such in stubbing the toes; or miro-trauma where the damage is built up over many years. In acute episodes, pain is usually present whereas in the latter, deformity happens over such a long period of time, pain is not a factor. There are two types of acquired toe deformities i.e. fixed deformities which involve osteoarthrosis: and buckled toes which are non-arthritic. The names given to these conditions are very descriptive.

When the toe is bent and fixed at the first knuckle, this condition is called "a hammer toe". If the toe is buckled and fixed at the second knuckle, then you have a mallet toe. Some people have both. Painful fixed toes may need to be surgically treated.

To make sense of the non-fixed deformities of toes we need to accept the foot changes shape when we walk. The muscles and tendons not only control this function but they also set the timing for movement. When the action of muscles are upset these may cause the toes to buckle. If the muscles outside the foot (extrinsic) are not working in unison, the toes are pulled away from ground contact, these are known as retracted toes.

If it is the muscles within the foot (intrinsic) that are at fault then the toes claw. For most of us these deformities have no serious impairment to normal activities and provided shoes have adequate room then we can live in total harmony with our curly toes. In others, such as people suffering from rheumatoid disease or diabetes mellitus, the condition is part of related pathologies.

Non-fixed toe deformities respond well to conservative treatment with customised splits which does not involve surgical treatment. Consult your podiatrist for more information.

Many concerned parents worry needlessly and seek medical/podiatric advice because the toes of their offspring, curl. However, I am very pleased to report parents’ concern is usually ill founded and they generally have nothing to worry about. They are of course, quite right to seek expert opinion and usually this is met with sympathetic reassurances.

Reviewed 12/06/2017

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