summary Syndactyly of the Toes is a congenital condition characterized by the fusion of the bone or skin in the foot digits. Diagnosis is made clinically. Treatment is usually observation as this is a painless aesthetic deformity. Epidemiology Incidence occurs in 1 in 2,000 births Anatomic location most frequently occurs between the second and third toe Etiology Pathophysiology cellular biology due to incomplete or absent apoptosis during gestation Genetics inheritance pattern most are autosomal dominant Associated conditions Familial Syndactyly Down`s Syndrome Klippel-Feil Syndrome Classification Two types simple if soft tissue only complex if bony fusion present Presentation Symptoms usually painless with cosmetic concerns only Imaging Radiographs AP of the foot Treatment Nonoperative observation indications simple syndactyly rarely requires treatment as this is an aesthetic deformity complications include contractures and painful scar tissue Operative digit release indications complex syndactyly