Curly toes do not usually cause any pain for young children. As adults however, overlapping of the toes in the standing position can create pain, discomfort, and difficulty wearing proper shoes. Having short flexor tendons can also cause the bone in the toe to grow crooked over time, which can lead to a more complex surgical correction later in life. A flexor tenotomy is a simple procedure used to release the flexor tendon and correct the deformity. This allows the toe to grow straight and avoids future complications.

Indications / Candidacy

Flexor tenotomies can be used to treat curly toes. Patients with this condition experience contracture of the flexor digitorum longus or flexor digitorum brevis in the foot. Curly toes are caused by a congenital shortening of the flexor tendons. Parents usually notice curly toes during the first few years of life, or as the child begins to walk. It is a common misconception to think that the 2nd toe is the problem, when in fact, it is usually the 3rd or 4th toe. The third toe may drift under the second toe causing the second toe to drift upward. The third toe can come close to touching the first. Ideal candidates for Flexor tenotomies are children who are walking independently and are at least 3 years of age. It is recommended that patients have their operation before the age of 5.

Good Candidates for Flexor tenotomies may experience the following:

  • Contracture of the flexor tendons of the 3rd or 4th toe
  • Toes that point down and curl towards the 2nd toe
  • Overlapping of the toes when standing

Treated Conditions

The Canadian Limb Lengthening Center offers treatment of many orthopedic conditions. We pride ourselves in providing highly specialized expert care and a holistic approach. Curly toe correction is just one of the techniques we use to correct deformity in our pediatric patients.


Curly toes

Surgical Technique

  1. Patients usually undergo sedation or general anaesthesia (this is due to their young age)
  2. The affected toe is injected with local anesthesia
  3. A small incision is made at the flexor tendon on the underside of the toe
  4. The tendons are then cut to release the contracture and straightening out the toe
  5. A small stitch is used to close the incision, glue is applied to help healing and a dressing is applied.


Correcting curly toe deformity at an early age prevents your child from experiencing more pain and difficulty in the future. Early intervention has a higher success rate than more invasive surgeries used to treat the condition during adulthood. Correction encourages the bone of the affected toe to grow straight. This allows the other toes to maintain their normal position and avoids overlapping. Approximately one week after surgery patients have typically healed and return quickly to their normal activities.

Potential Complications

As with any surgical procedure, flexor tenotomies can have difficulties and complications, but this is very rare. While educating patients on these potential risks, we take extensive measures to avoid complications and teach care givers how to properly care for their child after surgery. Our team of experts is well equipped to treat complications should they arise. Complications and side effects may include:

  • Patients being unable to curl their affected toe (this is to be expected only during the first year post-operatively)
  • Recurrence of the deformity (rare)

Pre-Operative Care

  • An extensive medical history will be taken during your initial assessments
  • It is recommended that you stay active, eat a healthy diet, and stop smoking prior to any operation
  • Certain medications and vitamins may need to be stopped several weeks before
  • Discuss all medications and over the counter drugs with your surgeon
  • Use a calendar or agenda to organize your pre and post appointment dates
  • Make arrangements for personal care givers

Post-Operative Care

  • Dressings will need to be kept dry for one week to allow the skin to heal
  • After one week dressings will be removed
  • Early movement and activity is recommended
  • Patients are allowed to fully weight bear as tolerated
  • Most patients find it comfortable to wear a large shoe or sandal for the first week while the toe heals
  • After one week, return to regular activity can start

Follow-ups after surgery

  • One week after surgery, to remove the dressings and assess the incisions.

Case studies


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Highly specialized expert care at CLLC

At the Canadian Limb Lengthening Centre we offer complex deformity correction and limb lengthening surgeries performed by experienced surgeons with the most up to date technologies. When it comes to your care, and treatment of deformity and limb length discrepancy, our surgeons have extensive training and experience.