Polydactyly of the Foot Workup

  • Author: Cara Novick, MD; Chief Editor: Dennis P Grogan, MD   more...
 
Updated: Feb 7, 2012
 

Imaging Studies

Radiographs are imperative prior to surgery so that the anatomy can be accurately understood and careful preoperative planning can be undertaken.[19] An anteroposterior and lateral radiograph should provide needed information.

More sophisticated imaging studies (eg, MRI) should be reserved for unusual cases.

Radiographic images of polydactyly are provided below:

Postaxial polydactyly in a 1-year-old child. In thPostaxial polydactyly in a 1-year-old child. In this case, the duplicated sixth toe was excised (dotted line), and the broad distal fifth metatarsal was narrowed. Preaxial polydactyly with longitudinal bracket epiPreaxial polydactyly with longitudinal bracket epiphysis. Mother and son with polydactyly. The patterns of dMother and son with polydactyly. The patterns of deformity are different.
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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.

Specialty Editor Board

Charles T Mehlman, DO, MPH  Professor of Pediatrics and Pediatric Orthopedic Surgery, Division of Pediatric Orthopedic Surgery, Director, Musculoskeletal Outcomes Research, 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 Orthopaedic Society of North America, and Scoliosis Research Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

George H Thompson, MD  Director of Pediatric Orthopedic Surgery, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, and MetroHealth Medical Center; Professor of Orthopedic Surgery and Pediatrics, Case Western Reserve University School of Medicine

George H Thompson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society

Disclosure: OrthoPediatrics None Consulting; Journal of Pediatric Orthopaedics Salary Management position; SpineForm None Consulting; SICOT None Board membership

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

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.

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. Hikosaka M, Ogata H, Nakajima T, Kobayashi H, Hattori N, Onishi F, et al. Advantages of open treatment for syndactyly of the foot: defining its indications. Scand J Plast Reconstr Surg Hand Surg. 2009;43(3):148-52. [Medline].

  9. Adam MP, Hudgins L, Carey JC, Hall BD, Coleman K, Gripp KW, et al. Preaxial hallucal polydactyly as a marker for diabetic embryopathy. Birth Defects Res A Clin Mol Teratol. Jan 2009;85(1):13-9. [Medline].

  10. 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].

  11. 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].

  12. 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].

  13. Morrison BE, D'Mello SR. Polydactyly in mice lacking HDAC9/HDRP. Exp Biol Med (Maywood). Aug 2008;233(8):980-8. [Medline].

  14. Auyeung J, Bhattacharya R, Birla R, Hide G, Henman P. The occult toe: an unusual case of polydactyly in the foot. J Pediatr Orthop B. Aug 24 2009;[Medline].

  15. Klaassen Z, Shoja MM, Tubbs RS, Loukas M. Supernumerary and absent limbs and digits of the lower limb: A review of the literature. Clin Anat. Jan 3 2011;[Medline].

  16. Jenkins S, Morrell DS. Ellis-van Creveld syndrome: case report and review of the literature. Cutis. Jun 2009;83(6):303-5. [Medline].

  17. Sund KL, Roelker S, Ramachandran V, Durbin L, Benson DW. Analysis of Ellis van Creveld syndrome gene products: implications for cardiovascular development and disease. Hum Mol Genet. May 15 2009;18(10):1813-24. [Medline].

  18. Belthur MV, Linton JL, Barnes DA. The spectrum of preaxial polydactyly of the foot. J Pediatr Orthop. Jun 2011;31(4):435-47. [Medline].

  19. 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].

  20. Nelman K, Weiner DS, Morscher MA, Jones KC. Multiplanar supramalleolar osteotomy in the management of complex rigid foot deformities in children. J Child Orthop. Feb 2009;3(1):39-46. [Medline].

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

  22. 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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The Venn-Watson classification of polydactyly is based on the anatomic configuration of the metatarsal and the duplicated bony parts.
Postaxial polydactyly in a 1-year-old child. In this case, the duplicated sixth toe was excised (dotted line), and the broad distal fifth metatarsal was narrowed.
Postoperative view of 1-year-old child who had postaxial polydactyly and excision of the sixth toe demonstrates a good result with straight lateral border.
Preoperative photograph of a 1-year-old child with preaxial polydactyly and significant varus of the duplicated toe.
Postoperative radiograph of a 1-year-old child with preaxial polydactyly who had significant varus of the duplicated toe demonstrates a good result after resection and metatarsal narrowing.
Preaxial polydactyly with longitudinal bracket epiphysis.
Mother and son with polydactyly. The patterns of deformity are different.
Image of an 8-year-old boy with a history of bilateral preaxial polydactyly. He had excision of bilateral duplicated digits at an outside institution.
Postoperative radiograph of an 8-year-old boy with a history of bilateral preaxial polydactyly and excision of the duplicated digits at an outside institution. He required additional surgery because of residual deformity. A good result is depicted following combination of the first metatarsal base with the second metatarsal shaft, creating a 5-digit foot.
Radiograph depicting a patient who had a history of bilateral preaxial polydactyly and excision of bilateral duplicated digits at an outside institution. He required additional surgery at age 8 years. Good results were obtained following combination of the first metatarsal base with the second metatarsal shaft, creating a 5-digit foot. At 20-year follow-up, the patient is doing well.
 
 
 
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