eMedicine Specialties > Orthopedic Surgery > Pediatrics

Polydactyly of the Foot

Author: Cara Novick, MD, Consulting Surgeon, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa
Coauthor(s): Dennis P Grogan, MD, Clinical Professor, Department of Orthopedic Surgery, University of South Florida College of Medicine; Chief of Staff, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa
Contributor Information and Disclosures

Updated: Nov 2, 2007

Introduction

Polydactyly is the most common congenital anomaly of the forefoot.1,2,3,4,5,6,7

History of the Procedure

Treatment for polydactyly of the foot has changed little over time. Removing the extra digit by disarticulation is the standard treatment.3,8,9,10

Problem

Polydactyly most commonly refers to the presence of 6 toes on one foot, but more toes are possible. Polydactyly may be associated with syndactyly. It most frequently occurs as an isolated trait with autosomal dominant inheritance and variable penetrance. Other patterns of inheritance, sporadic occurrence, and association with syndromes are also possible.1 (See also the eMedicine article Syndactyly.)

Frequency

Incidence is 1.7 cases per 1000 live births. Incidence is higher in blacks (3.6-13.9 cases per 1000 live births) than in whites (0.3-1.3 cases per 1000 live births).

Etiology

Polydactyly may occur as an isolated trait or in conjunction with certain syndromes, and there is a positive family history in 30% of cases. The syndromes with which polydactyly has been associated include Ellis-van Creveld syndrome, trisomy 13, tibial hemimelia, and trisomy 21. Polydactyly is bilateral in 50% of cases and has a slight male predilection. (See also the eMedicine articles Fibular Hemimelia and Ellis-van Creveld Syndrome, as well as the article Recognizing the Clinical Features of Trisomy 13 Syndrome on Medscape.)

Pathophysiology

Postaxial polydactyly (lateral ray) is the most common polydactyly,6 occurring in 80% of cases, followed by preaxial polydactyly (medial) and then central polydactyly. The duplication may range from a well-formed articulated digit to a rudimentary digit. Abnormalities of the associated metatarsal commonly occur in polydactyly. A morphologic classification was described by Venn-Watson,1 based on the configuration of the metatarsal (see Image 1), as follows:

  • Normal metatarsal with distal phalanx duplication
  • Block metatarsal
  • Y-shaped metatarsal
  • T-shaped metatarsal
  • Normal metatarsal shaft with wide head
  • Duplicated ray

A first metatarsal bracket epiphysis (longitudinal epiphyseal bracket) may occur in preaxial polydactyly.

Presentation

The patient may present in infancy or at a later date when cosmesis or shoe fit becomes a concern.

Obtain a thorough family history, and exclude association with syndromes. Perform a thorough musculoskeletal examination to exclude any other congenital anomalies or signs that occur with known syndromes.

Indications

Surgery is indicated to improve cosmesis and to improve shoe fit. It is usually performed when the patient is aged approximately 1 year, so the effect on development and walking is minimal. Surgery should be delayed until skeletal development (ossification) has occurred within the affected rays so that accurate anatomic assessment is possible.

Relevant Anatomy

See Intraoperative details.

Contraindications

No absolute contraindications to surgery exist. However, parents may choose not to excise the duplicate digit for personal reasons.

More on Polydactyly of the Foot

Overview: Polydactyly of the Foot
Workup: Polydactyly of the Foot
Treatment: Polydactyly of the Foot
Follow-up: Polydactyly of the Foot
Multimedia: Polydactyly of the Foot
References
[ CLOSE WINDOW ]

References

  1. Venn-Watson EA. Problems in polydactyly of the foot. Orthop Clin North Am. Oct 1976;7(4):909-27. [Medline].

  2. Beaty JH. Polydactyly. In: Operative Pediatric Orthopaedics. 2nd ed. Mosby-Year Book;1995:112-114.

  3. Hart ES, Grottkau BE, Rebello GN, Albright MB. The newborn foot: diagnosis and management of common conditions. Orthop Nurs. Sep-Oct 2005;24(5):313-21; quiz 322-3. [Medline].

  4. Herring JA. Polydactyly. In: Tachdjian's Pediatric Orthopaedics from the Texas Scottish Rite Hospital for Children. 3rd ed. WB Saunders Co;2001:1021-1024.

  5. Jones KL. Smith's Recognizable Patterns of Human Malformation. 5th ed. WB Saunders Co;1997.

  6. Lee HS, Park SS, Yoon JO, Kim JS, Youm YS. Classification of postaxial polydactyly of the foot. Foot Ankle Int. May 2006;27(5):356-62. [Medline].

  7. Turra S, Gigante C, Bisinella G. Polydactyly of the foot. J Pediatr Orthop B. May 2007;16(3):216-20. [Medline].

  8. Lim YJ, Teoh LC, Lee EH. Reconstruction of syndactyly and polysyndactyly of the toes with a dorsal pentagonal island flap: a technique that allows primary skin closure without the use of skin grafting. J Foot Ankle Surg. Mar-Apr 2007;46(2):86-92. [Medline].

  9. Morley SE, Smith PJ. Polydactyly of the feet in children: suggestions for surgical management. Br J Plast Surg. Jan 2001;54(1):34-8. [Medline].

  10. Mubarak SJ, O'Brien TJ, Davids JR. Metatarsal epiphyseal bracket: treatment by central physiolysis. J Pediatr Orthop. Jan-Feb 1993;13(1):5-8. [Medline].

  11. Yucel A, Kuru I, Bozan ME, Acar M, Solak M. Radiographic evaluation and unusual bone formations in different genetic patterns in synpolydactyly. Skeletal Radiol. Aug 2005;34(8):468-76. [Medline].

  12. Leeson MC, Wilcox PG, Weiner DS. Congenital duplication of the foot and toes. Foot Ankle. Jan-Feb 1985;5(4):191-7. [Medline].

  13. Weaver KM, Henry GW, Reinker KA. Unilateral duplication of the great toe with anterolateral tibial bowing. J Pediatr Orthop. Jan-Feb 1996;16(1):73-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

duplicate toe, extra toe, duplicate digit, extra digit, forefoot anomaly, syndactyly, Ellis-van Creveld syndrome, trisomy 13, tibial hemimelia, trisomy 21

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Cara Novick, MD, Consulting Surgeon, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa
Cara Novick, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and Pediatric Orthopaedic Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Dennis P Grogan, MD, Clinical Professor, Department of Orthopedic Surgery, University of South Florida College of Medicine; Chief of Staff, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa
Dennis P Grogan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association, Irish American Orthopaedic Society, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

Medical Editor

Charles T Mehlman, DO, MPH, Director, Musculoskeletal Outcomes Research, Associate Professor, Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center
Charles T Mehlman, DO, MPH is a member of the following medical societies: American Academy of Pediatrics, American Fracture Association, American Medical Association, American Orthopaedic Foot and Ankle Society, American Osteopathic Association, Arthroscopy Association of North America, North American Spine Society, Ohio State Medical Association, Pediatric Oncology Group, and Scoliosis Research Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

George H Thompson, MD, Professor of Orthopedic Surgery and Pediatrics, Department of Pediatric Orthopedic Surgery, Case Western Reserve University; Director, Rainbow Babies and Children's Hospital
George H Thompson, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, and Ohio State Medical Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dennis P Grogan, MD, Clinical Professor, Department of Orthopedic Surgery, University of South Florida College of Medicine; Chief of Staff, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa
Dennis P Grogan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association, Irish American Orthopaedic Society, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.