Lapidus procedure for Curly Toes
Other Common Names
Who does it affect?
Although the cause of curly toe deformity is unknown, it is thought to be familial in nature, with a high instance of bilaterality.
As curly toe deformity is frequently congenital, progression is limited, and cosmesis is the major concern of parents and caretakers.
- The deformity is often asymptomatic in children and may improve without intervention.
- With initiation of weight bearing and different stages of shoe wear, chronic skin irritation can develop, the toenail may become short and flattened, and other pressure phenomena such as corns and callosities may develop.
If you have symptoms of a curly toes, see a consultant for evaluation. You may need certain tests to rule out neurological disorders that can weaken your foot muscles, creating imbalances that bend your toes. Trauma and inflammation can also cause curly toe deformity.
Conservative treatment modalities, including splinting, taping, accommodative shoe wear, and protective padding, may relieve symptoms but are usually ineffective for correcting the deformity.
A longitudinal hockey stick–shaped or curvilinear incision is carried along the dorsomedial border of the fifth toe, from the level of the medial DIP joint distally to the fourth web space proximally. Through this incision, a thorough dorsomedial capsulotomy of the fifth MTP joint is made.
Any adhesions encountered between the plantar capsule and metatarsal head are released with a curved elevator to prevent hyperextension deformity of the MTP joint after capsular release.
The extensor tendon is carefully exposed, maintaining the extensor hood expansion, and the fifth toe is forcibly plantarflexed, causing the extensor tendon to become taut.
A second, 1-cm incision is made transversely over the taut EDL tendon at the mid-diaphyseal level of the fifth metatarsal.
Using this incision, an EDL tenotomy is performed. The distal limb of the EDL tendon is retrieved and then passed beneath the plantar aspect of the fifth toe from the dorsomedial DIP joint to the lateral aspect of the fifth MTP joint. The passed extensor tendon is then sutured to the conjoined tendon of the abductor and short flexor of the fifth toe. The fifth toe is held in an overcorrected position, and the transplanted extensor tendon is placed under slight tension prior to suture fixation.
Skin is closed with interrupted sutures or with advancement techniques if significant skin contractures are present.
Postoperatively, the toe is dressed in a corrected position and weight bearing in a postoperative shoe is allowed. Sutures are removed at 2 weeks, and the toe is then taped in a corrected position for another 4 to 6 weeks. Regular shoe wear is allowed at 4 to 6 weeks.
Alternatively, if there is concern about the strength of the repair, the operative foot is maintained in a splint for a total of 3 to 4 weeks, and progression to full weight bearing and activity in a wide toebox shoe is gradually allowed.
In most cases, Lapidus procedure results in satisfactory outcomes for patients. However, possible complications include:
- Mild swelling
- Clinically insignificant postoperative edema
- Circulatory insult and wound healing problems are potential risks of the Lapidus procedure.
- Recurrence of deformity has also been reported.