Introduction Macrodactyly is nonhereditary congenital digit enlargement. Epidemiology Incidence very rare Anatomic location 90% are unilateral 70% involves more than one digit index involved most frequently in order of decreasing frequency, the long finger, thumb, ring, and small are also involved can involve digits of the hand or foot Risk factors none known Etiology Pathophysiology etiology unknown no genetic correlations known to date affected digits correspond with neurologic innervation the median nerve being the most common Associated conditions lipfibromatous hamartoma of the median nerve is the adult homolog has been associated with: Proteus syndrome Banayan-Riley-Ruvalcabe's disease Maffucci syndrome Ollier’s disease Milroy’s disease Classification Functional Classification Static Present at birth and growth is linear with other digits Progressive Not as noticeable at birth but shows disproportionate growth over time Presentation History asymmetry to digits can be present at birth or appearing over time Symptoms pain inability to use digits complaints of cosmetic issues Physical exam inspection & palpation thick, fibrofatty tissue involving enlarged digits ROM & instability often limited ROM due to soft tissue constraints Imaging Radiographs recommended views biplanar hand radiographs findings enlarged phalanges to involved digits may see malalignment of joints or angled phalanges CT, MRI not typically needed Studies Angiography only needed if used for surgical planning Treatment Nonoperative observation in mild cases Operative epiphysiodesis indications single digit perform once digit reaches adult length of same sex parent most common approach postoperative care soft tissue care early ROM osteotomies and shortening procedures indications thumb involvement multiple digit involvement severe deformity postoperative care local soft tissue care early ROM amputations indications severe involvement of digit non-reconstructable digit Complications Digital stiffness Chronic digital pain or edema Prognosis If static, asymmetry does not worsen If progressive, asymmetry worsens with time