It is almost cliché to respond to “How is your new baby doing?” with “Got 10 fingers and 10 toes”.
The first thing parents do with their newborn is count the fingers and toes. It is a tradition to count all your newborn’s fingers and toes to prove that “everything is all right”. But it should not stop there.
First, just because all 10 toes are present does not mean they do not have an abnormality. And second, even if there is an abnormality, that does not mean you don’t have a healthy and wonderful child!
There are a few toe deformities that occur in children that have a strong family trait. You may see them in siblings, parents, or grandparents. This is a red flag to look for the same condition with the birth of a new child.
Let’s review some of these conditions. The common thread for all of them is early evaluation for the best long-term outcome. Early treatment, if needed, can prevent problems in adolescence and adult hood.
As the name implies, “curly toe” is a relatively common deformity. A toe bends down and sideways into a curled “C” shape. The toe may underlap a neighboring toe.
The fourth and fifth toes are often most affected. The fourth toe can curl under the third or the fifth toe curls beneath the fourth.
Although the appearance can be alarming, having one or more curly toes will typically not cause a newborn any pain or discomfort. Symptoms may start when a child begins to walk and wear shoes. Shoes may produce pain, calluses, blisters, and nail problems.
Curly toes can be treated without surgery if a child is still young and their tissues are more flexible. Holding the toe in a splint and massaging/stretching can help.
Once past the age of 5 or 6, however, surgery will provide better results and is the recommended choice of treatment. Often, the tight tendon that is causing the toe to become pulled down must be released or lengthened.
Webbed Toes (Syndactyly)
Another common condition, webbed toes, occur in 1 in every 2,000-3,000 babies. The skin is joined between the toes. (These kids will be good swimmers.) The connection between the toes can either be partially or fully webbed. The second and third toes are the most commonly affected.
This deformity is usually cosmetic in nature, and rarely causes any physical problems. If it is not producing discomfort, some parents will let their child decide when to address later in life. The biggest problem is teasing from other kids. Adolescence can be so cruel.
Surgical and conservative treatment is most effective at younger ages, when skin and collagen are more flexible. A “de-webbing” surgery is not as simple as just cutting the extra skin away. We must ensure of rotating remaining flaps of skin to cover the toes and maintain good blood supply. More complex cases may involve extra bones, nerves, blood vessels, or toenails.
Extra Bonus Toes (Polydactyly)
Finding more than five toes on one foot can come as a shock. This is another condition that will typically produce little harm to a newborn or very young child. The issue can be more of a cosmetic one, but a large extra toe could have functional limitations.
Removal of an extra toe is dependent on the complexity. In some cases, the “extra toe” is merely a stalk that does not contain any bone or vital structures. In other cases, an extra toe may have its own metatarsal, or be sharing a metatarsal with a neighboring toe.
Amniotic Band Syndrome
Of all the infant toe problems, this is the devastating one. There are long strings/bands that float around in the uterus. If one of these bands wraps around a toe (5th toe is the most common), it can stop the blood flow like a tourniquet. The digits may be swollen and dusky or even absent at birth.
If not addressed immediately, the digit can be lost due to lack of blood flow. The good news is this is typically caught right away by the delivery team.
The More You Know (and the Earlier), the Better
Childhood toe deformities may feel like they require a snap judgment for treatment, but they are almost never an emergency situation. You will almost always have some time before a decision needs to be made.
With that said, do not wait to have an initial discussion about your child’s condition. It is never too early to be well informed. Knowing what you can do sooner can give you greater peace of mind.
Additionally, it is very helpful to know your family’s history of foot and ankle conditions. We stand by the notion that family history should be a fundamental element of a child’s foot care. With this “heads up” warning, we can look for hereditary foot problems at birth. Parents can prepare and avoid potential problems later on in life.
So do not be afraid to start discussing what foot or ankle problems your family has in your bloodline. It can very well help us detect and treat conditions much earlier!
And if you’re wondering how to bring the topic up, take the family to Arby’s, sit down and say, “You know, these curly fries just reminded me of something I’ve wanted to ask about…”
(OK, we don’t actually recommend trying that. But if you do, please let us know how it goes.)
Or just wait until the next summer family reunion to see which side of the family to blame. Remember, the apple does not fall far from the tree.
We will always be here to help you with any concerns you have about your child’s foot or ankle health. Call our Indianapolis office at (317) 545-0505 or fill out our online contact form to schedule an appointment.