Congenital duplication of the foot and toes

Surgical management and postoperative evaluation based on morphological classification in central polydactyly of the foot

PURPOSE

Central polydactyly of the foot is rare, with few reports on surgical methods and treatment indications. In this study, based on the experience of central polydactyly in our department, we will consider morphological classification and describe our treatment plan.

METHOD

In this retrospective study, 11 patients (11 digits) with central polydactyly were identified among 136 patients of polydactyly of the foot (2009-2018). They were classified according to morphologic characteristics: type I, the duplicated digits are independent of each other; type II, digits of the same size are duplicated; and type III, digits of different sizes are duplicated.

RESULTS

In morphologic classification, there were 4 cases of type II and 7 cases of type III, but there was no case of type I. For type II, surgery was performed using the Bilhaut-Cloquet (BC) procedure in 2 patients, bone-removing flap (flap) method in 1 patient, and simple ablation in 1 patient. For type III, surgery was performed using the BC procedure in 1 patient, flap method in 3 patients, simple ablation in 2 patients, and ligation in 1 patient with floating type.

CONCLUSION

In order to obtain good cosmetic results in digits of morphologic classifications type II and III, it is necessary to select the surgical approach with careful consideration of every feature.

Central-type eight-toed polydactyly associated with ipsilateral complex renogluteal agenesis: a case report with 8 years' follow-up

At birth, a baby girl was found to have central-type eight-toed polydactyly of the left foot associated with ipsilateral nonvisualization of the kidney and atrophy of the gluteal maximum muscle. X-ray examination showed eight completely developed metatarsal and digit bones, and a chromosome study showed a normal 46, XX karyotype. She received ray amputation of the extra toes when she was 1 year old. Follow-up examination at age 9 showed unchanged renogluteal anomalies and a slightly smaller left foot. In addition, a bony defect over the posterior iliac spine and a wide femoral neck-shaft angle were found on the radiograph. Her left leg was found to be 1 cm shorter than the right, but there was no evidence of valgus or varus. Presently she can walk and run quite well, and there is no callus formation over her sole. The timing and options for excision of the supernumerary digits are discussed and this rare disease reviewed.

A new surgical technique for postaxial polydactyly of the foot

A new technique for the treatment of the most common type of postaxial polysyndactyly of the foot is presented. The technique employs four local flaps and a skin graft from the pedal area. The outermost skeletal elements and nail tissue were excised, while the fourth interdigital commissure was deepened. This differs from historical techniques of desyndactylization in the hand that have been applied to surgery in the foot. The new technique is characterized by minimal waste of tissue from the outermost toe with preservation of the dominant fifth toe.

Human malformations similar to those in the mouse mutation disorganization (Ds)

We report two patients with malformations similar to those seen in mice with the disorganization (Ds) mutation. The first case has a body wall defect, limb malformation, and hamartoma, while the second case has a partially duplicated foot, in addition to the other anomalies. We discuss the implications that recent advances regarding the genetic analysis of the mouse Ds locus have for the search for the human homologue.

Classification of polydactyly of the hands and feet

The authors present a new classification of polydactyly based on radiomorphological alterations. The malformations are defined in two directions, as in a system of coordinates. The longitudinal arrangement is based on the pathogenetic principle of bifurcation of a finger or a toe ray from distal to proximal. We accordingly divided polydactylies into five types: distal phalanx, middle phalanx, proximal phalanx, metacarpal or metatarsal, carpal or tarsal. The transverse arrangement indicates which rays are involved. All polydactylies, including the special forms such as rudimentary manifestations, triphalangism, and multiple duplications, can be incorporated into this simple basic scheme. Depending on their characteristics, the special forms are further subdivided, e.g., into a distal or proximal phalanx type with simple or double triphalangism, or a tarsal type with third-degree duplication and first-degree aplasia. Numerous radiological examples and schematic drawings illustrate the classification. The advantage of the classification is that it depends exclusively upon the skeletal finding and all manifestations are registered according to a simple scheme longitudinally and transversely. This makes them codifiable for the computer and suitable for multicenter studies. The special forms, the rudiment, triphalangism, and multiple duplication, can easily be further subclassified. Moreover, the nomenclature is simple and is oriented to anatomical terminology.