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Updated: Jun 15 2021

Polydactyly of Foot

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  • summary
    • Polydactyly of Foot is a common congenital autosomal dominant condition caused by the failure of differentiation in the apical ectodermal ridge during the first trimester of pregnancy that presents with extra digits of the foot.
    • Diagnosis is made clinically with the presence of extra digits in the foot. 
    • Treatment is usually observation. Surgical treatment is indicated for painful malaligned toes that normal prevent shoe wearing. 
  • Epidemiology
    • Incidence
      • occurs in 1 in 500 births
      • postaxial (lateral side of the foot) polydactyly is most common
    • demographics
      • more common in African-Americans than caucasians
  • Etiology
    • Pathophysiology
      • failure of differentiation in the apical ectodermal ridge during first trimester of pregnancy
    • Genetics
      • usually transmitted as autosomal dominant (positive family history)
    • Associated conditions
      • orthopaedics manifestations
        • may involve extra phalanges or even duplicated rays
  • Classification
    • Venn-Watson Classification of Polydactyly
      • post-axial (lateral side of the foot)
        • 'Y' metatarsal
        • 'T' metatarsal
        • wide metatarsal head
        • complete duplication
      • central (not part of the original classification)
        • duplication of the second, third or fourth toe
      • pre-axial (medial side of the foot)
        • short block first metatarsal
        • wide metatarsal head
  • Presentation
    • Physical exam
      • extra digits in the foot
  • Imaging
    • Radiographs
      • metatarsals are present on radiographic views at birth, but generally radiographic evaluation delayed to allow full ossification of the phalanges for surgical planning
  • Treatment
    • Nonoperative
      • observation
        • indications
          • postaxial or central polydactyly
            • with proper alignment of the digit may remain in place unless the foot is significantly widened (rare)
    • Operative
      • ablation of extra digit (usually border digit)
        • indications
          • malaligned toe, particularly preaxial polydactyly
            • perform at 9-12 months of age if possible
            • small skin tags can be removed in newborn nursery
  • Prognosis
    • Natural history of disease
      • may cause problems with shoe fitting and angular deformity of the toes
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