Curly Toes

What is it?

Curly toes are a shape change in the smaller toes, usually there from birth. One or more toes curl under the toe next to them, towards the sole of the foot. They often affect the third, fourth and fifth toes, or mainly the fourth and fifth, as it isn't clear which toes are affected most often.

The cause is a tight tendon (a cord that connects muscle to bone) under the toe. It pulls the toe out of line, so the toe bends down and tilts sideways at its joints.

Curly toes are one of several bent toe shapes, alongside mallet, hammer, claw and crossover toes.

Who does it affect?

Curly toes are common. They are the most common bent toe shape that babies are born with, and about 2 to 3 per cent of people have them. In newborns, the figure is 2.8 per cent when curly and overlapping toes are counted together.

Most cases start in childhood, and curly toes are one of the most common things podiatrists see in babies and young children. The outer toes are the ones most often involved, and it often affects both feet. Some adults have curly toes too.

Signs and symptoms

The main sign is one or more toes curling under the toe next to them. Most children and adults have no problems from it. Many parents bring a child in because of how the toes look, or because of pain when walking.

Some children do get symptoms. These can include rubbing or pain, hard skin or corns, changes to the nail, and trouble finding shoes that fit. Curly toes are usually there from birth and may become more noticeable once a child starts walking.

A toe is either supple (flexible) or fixed. If the toes stay supple (flexible), they remain curly without causing problems. Sometimes a toe becomes fixed as the joint tightens, but this isn't known to cause problems later in life.

For which signs mean you should book a visit or get seen, see "When to see a podiatrist".

What causes it?

Curly toes happen when a tight tendon under the toe pulls it under the toe next to it. The outer toes are most often affected.

Why the tendon is tight isn't known. Curly toes seem to run in families, and may be passed from parent to child. The tendon may also tighten during fast growth, or from the way a baby lies in the womb. A toe bone shaped like a triangle rather than a rectangle may play a part. Occasionally the cause is a bone problem, not the tendon.

Most cases start in childhood. Some adult cases may follow wearing certain shoes, or have no known cause.

Tell your podiatrist or doctor if other family members have curly toes.

How is it diagnosed?

A doctor diagnoses curly toes by checking the feet and toes, and in most cases this is enough. Sometimes an X-ray or ultrasound is added; standing X-rays may be considered in children over 2.

If you notice a curly toe in a baby or child, see "When to see a podiatrist". Most need only reassurance. Most need only reassurance.

Note which toes are affected, whether a toe straightens when moved gently, and any rubbing, hard skin or nail changes. Check shoes are wide and deep enough.

Rarely, a nerve or muscle cause is possible, such as curly toes starting suddenly along with other foot deformities in a child, or all the toes curling tightly with a very high arch. These need a doctor's check and MRI scan; see "When to see a podiatrist".

Treatment

Many curly toes need no treatment. If a toe causes no pain, you can leave it alone.

Looking after it at home

The usual first step is gentle stretching. Stretch the toes straight once a day, for example when drying them after a bath or as part of a bedtime routine. This keeps them supple.

Choose shoes with enough width and depth, so the toes don't rub together. Trim nails properly so they don't dig into the toe next door.

Treatment from your podiatrist

For a child with no symptoms, your podiatrist may suggest watching the toes for up to a year. This usually means stretching, roomy shoes and a check-up every 6 months.

If blisters or corns are starting, toe cushions and wide-toed shoes are tried first. Toe spacers (soft pads that sit between the toes) may help stop rubbing, though young children may not tolerate them. Spacers don't correct the shape of the toe. If rubbing or blisters continue despite wide shoes and cushioning, see "When to see a podiatrist".

Other options

Taping a curly toe to its neighbour is used by some clinicians, but it isn't clear whether it helps. Taping may help in newborns, possibly because their toes are so soft and easy to move. In older children, the gains from taping or strapping are often lost once it stops. Taping may not help at all. If a child's symptoms get worse, taping may be worth trying.

Surgery

Surgery is kept for a small number of children whose toes cause real trouble, such as ongoing painful blisters, rubbing, or skin or nail breakdown. It is only considered if cushions and wide shoes haven't worked because the toe is fixed in a curled position. In tendon release surgery, the tight tendon on the underside of the toe is cut and released. A painful toe usually settles over some weeks afterwards.

Surgery is mainly used for moderate to severe curling. For these toes, surgery can work better and last longer than non-surgical care. It isn't a good idea when the shape of the toe is the only problem, because the risks are probably too high. It can also do harm if the toe already moves normally.

Risks include bleeding, infection and, very rarely, nerve injury or loss of blood supply to the toe. Complications or the need for further surgery can happen within the first few years. Before agreeing to an operation, ask the surgical team about the expected benefits, risks and recovery.

For warning signs, including after surgery, see "When to see a podiatrist".

Recovery

The outlook for children is generally good. Curly toes often cause no trouble and usually improve with age. Most bent toe shapes in children ease as the child grows, and curly toes often correct themselves once a child starts to walk.

About 25 to 50 per cent of curly toes get better on their own. Toes that don't get better on their own may need further treatment, though referral is usually needed only for a fixed toe causing pain, nail irritation or blistering.

Which toes will improve and which will stay curly isn't clear yet.

Preventing it

Nothing is known to prevent curly toes. In children, curly toes usually improve slowly as the feet grow. Toe splints or special shoes do not change this natural course, and it isn't clear whether taping or strapping makes a lasting difference.

It is worth checking the toes again if they begin to rub or get sore, or if your child's activity changes. See "When to see a podiatrist".

When to see a podiatrist

When to book

Book an appointment with your podiatrist if:

• your pain hasn't improved after a few weeks of home care
• foot pain is stopping you from doing your usual activities
• you can't find comfortable shoes, or a lump or bump on your foot makes shoes hard to wear
• you have an ingrown toenail
• your smaller toes are becoming bent, crossed or painful

When to get help sooner

Get urgent medical assessment (see your GP today, or go to an urgent care clinic or the nearest emergency department) if:

• you have had foot surgery and the wound becomes red, hot, swollen or more painful, or has pus or a bad smell
• you have had foot surgery and the wound opens, keeps bleeding or starts to leak
• the skin on your toes or foot turns dark or black, or a wound turns black and smells bad: go straight away, without waiting for an appointment

See your podiatrist or GP soon if:

• the skin over a bunion or another bony bump on your foot is broken, blistered or starting to break down
• your child's foot shape is getting worse

Frequently asked questions

Do curly toes affect walking or running?

Usually not. Curly toes mostly need no treatment and don't get in the way of walking or running. Most children move and play as they always do. For signs that mean a visit, see "When to see a podiatrist".

Is it worth taping my baby's toes?

Taping or strapping babies' toes was used in the past, and it isn't clear whether it helps. If you are thinking about it, ask your podiatrist first. They can tell you whether it suits your baby's toes.

Further reading

• Curly Toes | Common Health Issues - Child 1 to 4 years | Child 1 - 4 years | Healthier Together NHS
• Royal Orthopaedic Hospital - Children's Curly Toes NHS
• Curly Toes NHS
• Curly toes in children - South Tees Hospitals NHS Foundation Trust NHS
• Curly toes - Buckinghamshire Healthcare NHS Trust - CYP Website NHS