the most common reason for toes to be deformed at a young age is a tendon imbalance between the flexors and extensors of the foot. for example, having a high arch or a cavus type foot, leads to the extensor tendons bowstringing and hammertoe formation. Using a custom orthotic from a foot and ankle specialist may help balance deforming forces. others have advocated taping the toes in an improved position but I never tape children's toes as it potentially can strangulate the toes and cause gangrene. with a certain type of flatfoot, the fourth and fifth toes turn inward due to imbalance of intrinsic tendons of the foot. although these may be cosmetically unappealing I would never consider surgery until all growth plates close after around 18 years of age, and usually don't ever cause negative symptoms