Curly Third and Fourth Toes
This is very common. It is due to a minor imbalance of the small muscles in the foot. These toes rarely cause problems even though they tend to sit under the next toe. Curly toes are never the reason for late walking in a child.
If the toe causes no pain there is no need for treatment. Strapping the toe or toe spacers do not correct the toe shape. Indications for intervention are pain, skin or nail breakdown. In those instances, only will a flexor tenotomy be considered. This will straighten the toe to stop the child walking on their nail, but the shape will remain curly. If toe shape is the only problem the risks of surgery are probably too high
Over-riding Second Toe
An over-riding second toe is where the second toe lies cocked up above the first and third toes. This is usually found in the smaller, slightly fatter foot of a baby or an infant. The foot as it grows will become thinner, and as it begins to take the weight of the body it spreads wider. The toe usually then comes to lie in line with the others. Treatment with strapping has no benefit and is not needed for something that will get better with growth.
Webbing between the second and third toes is common. It never causes symptoms even if complete and attempts to separate the toes with surgery can cause major problems with skin healing and infections. The fear that the child will be teased rarely occurs because children seldom go far with bare feet. The webbing is not easy to see in an active child.
Over-riding Fifth Toes
In this condition the fifth toe lies on top of the fourth toe. Sometimes it looks quite striking but often is not troubling. If there is pain, or the parents are unable to find footwear that does not rub, then treatment may be required. Strapping or splints do not seem to help so surgery may be considered. However, there can be complications of such surgery and therefore it reserved for when the toe is causing significant problems.
In the adolescent bunions may begin to develop. There is usually a family history of hallux valgus when presenting as an adolescent. It is much more common in females. Shoes are important. Fashion shoes with pointed toes are especially harmful. Parent should be advised that any wide based shoe that fits well, including trainers and sandals, are perfectly OK. There is no treatment, other than wearing shoes that fit and possibly barefoot walking, which can prevent hallux valgus from developing. Surgery may eventually become necessary for severe cases. Surgical correction is best left till adulthood since the bunions tend to recur rapidly if the foot is still growing.