Imaging Studies

It is imperative that radiographs (see the images below) be obtained before surgical treatment so that the anatomy can be accurately understood and careful preoperative planning can be undertaken.^[28]Anteroposterior (AP) and lateral radiographs should provide needed information. More sophisticated imaging studies (eg, magnetic resonance imaging [MRI]) should be reserved for unusual cases.

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.

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Preaxial polydactyly with longitudinal bracket epiphysis.

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Mother and son with polydactyly. The patterns of deformity are different.

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Treatment & Management

Al Amin ASM, Carter KR. Polydactyly. Treasure Island, FL: StatPearls; 2022. [Full Text].
Farrugia MC, Calleja-Agius J. Polydactyly: A Review. Neonatal Netw. 2016. 35 (3):135-42. [QxMD MEDLINE Link].
Venn-Watson EA. Problems in polydactyly of the foot. Orthop Clin North Am. 1976 Oct. 7 (4):909-27. [QxMD MEDLINE Link].
Beaty JH. Polydactyly. Canale ST, Beaty JH, eds. Operative Pediatric Orthopaedics. 2nd ed. St Louis: Mosby-Year Book; 1995. 112-4.
Hart ES, Grottkau BE, Rebello GN, Albright MB. The newborn foot: diagnosis and management of common conditions. Orthop Nurs. 2005 Sep-Oct. 24 (5):313-21; quiz 322-3. [QxMD MEDLINE Link].
Polydactyly. Herring JA, ed. Tachdjian’s Pediatric Orthopaedics: From the Texas Scottish Rite Hospital for Children. 6th ed. Philadelphia: Elsevier; 2022. Vol 1: 778.
Lee HS, Park SS, Yoon JO, Kim JS, Youm YS. Classification of postaxial polydactyly of the foot. Foot Ankle Int. 2006 May. 27 (5):356-62. [QxMD MEDLINE Link].
Turra S, Gigante C, Bisinella G. Polydactyly of the foot. J Pediatr Orthop B. 2007 May. 16 (3):216-20. [QxMD MEDLINE Link].
Morrison BE, D'Mello SR. Polydactyly in mice lacking HDAC9/HDRP. Exp Biol Med (Maywood). 2008 Aug. 233 (8):980-8. [QxMD MEDLINE Link]. [Full Text].
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. 2009 Nov. 18 (6):362-4. [QxMD MEDLINE Link].
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. 2011 Jul. 24 (5):570-5. [QxMD MEDLINE Link].
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. 2007 Mar-Apr. 46 (2):86-92. [QxMD MEDLINE Link].
Morley SE, Smith PJ. Polydactyly of the feet in children: suggestions for surgical management. Br J Plast Surg. 2001 Jan. 54 (1):34-8. [QxMD MEDLINE Link].
Mubarak SJ, O'Brien TJ, Davids JR. Metatarsal epiphyseal bracket: treatment by central physiolysis. J Pediatr Orthop. 1993 Jan-Feb. 13 (1):5-8. [QxMD MEDLINE Link].
Kim JS, Fowler JR, Davit AJ. Operative technique and management of central foot polydactyly. JPRAS Open. 2022 Jun. 32:61-71. [QxMD MEDLINE Link]. [Full Text].
Ishigaki T, Akita S, Udagawa A, Suzuki H, Mitsukawa N. Central polydactyly of the foot: An experience of a treatment of 22 patients. J Orthop Sci. 2021 Dec 15. [QxMD MEDLINE Link].
Jenkins S, Morrell DS. Ellis-van Creveld syndrome: case report and review of the literature. Cutis. 2009 Jun. 83 (6):303-5. [QxMD MEDLINE Link].
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. 2009 May 15. 18 (10):1813-24. [QxMD MEDLINE Link]. [Full Text].
Umair M, Ahmad F, Bilal M, Ahmad W, Alfadhel M. Clinical Genetics of Polydactyly: An Updated Review. Front Genet. 2018. 9:447. [QxMD MEDLINE Link]. [Full Text].
Baas M, Burger EB, van den Ouweland AM, Hovius SE, de Klein A, van Nieuwenhoven CA, et al. Variant type and position predict two distinct limb phenotypes in patients with GLI3-mediated polydactyly syndromes. J Med Genet. 2021 Jun. 58 (6):362-368. [QxMD MEDLINE Link].
Palencia-Campos A, Martínez-Fernández ML, Altunoglu U, Soto-Bielicka P, Torres A, Marín P, et al. Heterozygous pathogenic variants in GLI1 are a common finding in isolated postaxial polydactyly A/B. Hum Mutat. 2020 Jan. 41 (1):265-276. [QxMD MEDLINE Link].
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. 2009 Jan. 85 (1):13-9. [QxMD MEDLINE Link].
Ortiz-Cruz G, Luna-Muñoz L, Arteaga-Vázquez J, Mutchinick OM. Isolated postaxial polydactyly: Epidemiologic characteristics from a multicenter birth defects study. Am J Med Genet A. 2019 Aug. 179 (8):1432-1441. [QxMD MEDLINE Link].
Burger E, 't Hart J, Hovius S, Van Nieuwenhoven C. Quality of life in children with preaxial polydactyly of the foot in comparison to adults, postaxial polydactyly and healthy controls. J Pediatr Orthop B. 2022 Sep 20. [QxMD MEDLINE Link].
Belthur MV, Linton JL, Barnes DA. The spectrum of preaxial polydactyly of the foot. J Pediatr Orthop. 2011 Jun. 31 (4):435-47. [QxMD MEDLINE Link].
Seok HH, Park JU, Kwon ST. New classification of polydactyly of the foot on the basis of syndactylism, axis deviation, and metatarsal extent of extra digit. Arch Plast Surg. 2013 May. 40 (3):232-7. [QxMD MEDLINE Link]. [Full Text].
Burger EB, Hovius SE, Burger BJ, van Nieuwenhoven CA. The Rotterdam Foot Classification: A Classification System for Medial Polydactyly of the Foot. J Bone Joint Surg Am. 2016 Aug 3. 98 (15):1298-306. [QxMD MEDLINE Link].
Yucel A, Kuru I, Bozan ME, Acar M, Solak M. Radiographic evaluation and unusual bone formations in different genetic patterns in synpolydactyly. Skeletal Radiol. 2005 Aug. 34 (8):468-76. [QxMD MEDLINE Link].
Kubat O, Antičević D. Does timing of surgery influence the long-term results of foot polydactyly treatment?. Foot Ankle Surg. 2018 Aug. 24 (4):353-358. [QxMD MEDLINE Link].
Park GH, Jung ST, Chung JY, Park HW, Lee DH. Toe component excision in postaxial polydactyly of the foot. Foot Ankle Int. 2013 Apr. 34 (4):563-7. [QxMD MEDLINE Link].
Liao W, Jiang L, Zheng P. On-Top Plasty at the Level of the Metatarsal Neck for Treatment of Polydactyly. Front Pediatr. 2022. 10:931148. [QxMD MEDLINE Link]. [Full Text].
Mozaffarian K, Vosoughi AR, Mozaffarian D. On-Top Plasty in Post-Axial Polydactyly: A Case Report and Recommendation to Modify the Classifications. J Hand Surg Asian Pac Vol. 2022 Jun. 27 (3):548-552. [QxMD MEDLINE Link].
Burger EB, Bus SA, Hovius SER, van Nieuwenhoven CA. Lateral Versus Medial Hallux Excision in Preaxial Polydactyly of the Foot. Foot Ankle Int. 2020 Dec. 41 (12):1553-1562. [QxMD MEDLINE Link].
Ferman DH, Bauler LD, Bovid K. Surgical Reconstruction Technique of Two Patients With Tarsal Type Preaxial Polydactyly: Two True Prehalluces. J Foot Ankle Surg. 2019 Jul. 58 (4):814-820. [QxMD MEDLINE Link].
Osborn EJ, Davids JR, Leffler LC, Gibson TW, Pugh LI. Central polydactyly of the foot: surgical management with plantar and dorsal advancement flaps. J Pediatr Orthop. 2014 Apr-May. 34 (3):346-51. [QxMD MEDLINE Link].
Nelman K, Weiner DS, Morscher MA, Jones KC. Multiplanar supramalleolar osteotomy in the management of complex rigid foot deformities in children. J Child Orthop. 2009 Feb. 3 (1):39-46. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

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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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, Pediatric Orthopaedic Society of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Orthopaedic Association, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, American Academy of Orthopaedic Surgeons

Disclosure: Received none from OrthoPediatrics for consulting; Received salary from Journal of Pediatric Orthopaedics for management position; Received none from SpineForm for consulting; Received none from SICOT for board membership.

Chief Editor

Jeffrey D Thomson, MD Professor of Orthopedic Surgery, University of Connecticut School of Medicine; Orthopedic Surgeon, Connecticut Children’s Medical Center

Jeffrey D Thomson, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Pediatric Orthopaedic Society of North America, Scoliosis Research Society

Disclosure: Nothing to disclose.

Additional Contributors

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, Scoliosis Research Society, Pediatric Orthopaedic Society of North America, 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

Disclosure: Nothing to disclose.

Polydactyly of the Foot Workup

Imaging Studies

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