eMedicine Specialties > Orthopedic Surgery > Pediatrics

Polydactyly of the Foot: Treatment

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

Treatment

Surgical Therapy

Surgical treatment consists of excision of the duplicated digit and reconstruction of any associated abnormalities in the remaining rays (eg, longitudinal epiphyseal bracket).3,8,9,10

Preoperative Details

A thorough preoperative examination should be undertaken, including evaluation of radiographs, to formulate an operative plan.

Intraoperative Details

Most medial digits in preaxial polydactyly and most lateral digits in postaxial polydactyly are usually resected. This allows the foot to be narrow, with a straight medial or lateral border.

In postaxial polydactyly, a racquet-shaped or oval incision is made at the base of the most lateral digit and carried through skin and fascia. Tendons are divided as distally as possible. The capsule of the metatarsophalangeal (MTP) joint is divided, and the digit is disarticulated. Care is taken to remove T or Y extensions of the metatarsal head or to reshape an expanded metatarsal head. The capsule is repaired, the skin closed, and a bandage or cast applied.

In preaxial polydactyly, the medial toe is usually excised. The toe is again removed through disarticulation. Care must be taken to appropriately balance the abductor and adductor hallucis muscles and to minimize hallux varus. Correction of an associated longitudinal bracket epiphysis helps to prevent the development of hallux varus and an excessive short first metatarsal (see the eMedicine article Hallux Varus). The capsule is repaired as accurately as possible. If the more lateral toe is hypoplastic and is excised, the intermetatarsal ligament must be reapproximated. A Kirschner wire (K-wire), in place for 4-6 weeks, may be helpful in maintaining position and avoiding varus deformity. A soft dressing or cast may be used.

In central polydactyly, a dorsal racquet-shaped incision is made at the base of the duplication. The extra digit is excised through disarticulation. The intermetatarsal ligament is reapproximated prior to closure. A cast or orthosis may be useful postoperatively to minimize a residual widened forefoot. A careful plastic skin closure is used in all patients, as cosmesis is a concern.

Postoperative Details

A cast or soft dressing is used. If a K-wire is used, it is usually left in place for 4-6 weeks. A walking cast allows the small child to be active and at the same time protects the surgical incision.

Follow-up

The patient must be monitored and evaluated for residual or future deformity.

Complications

The most common complication in preaxial polydactyly is hallux varus. This may cause pain and difficulty with shoe wearing, warranting subsequent surgical correction. Failure to correct a longitudinal bracket epiphysis that may be associated with a duplicate great toe can result in the development of hallux varus. The deformity should be addressed when noted. The bracket can be resected to allow for untethered growth, and the varus can be corrected with capsulorrhaphy and K-wire fixation at the MTP joint. Resection and metatarsal osteotomy may occasionally be needed in the older child.

Patients with postaxial polydactyly may have residual angular deformity, including angulation at the MTP joint and bowing of the metatarsal. This is usually not clinically significant.

In patients with central polydactyly, a widened forefoot is a common complication.

All patients are at risk for developing MTP joint subluxation or angular deformity and residual deformities of the metatarsal head. Incomplete excision of elements that are not yet ossified may also lead to future problems or deformity.

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
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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].

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Further Reading

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Keywords

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

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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.

 
 
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