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