Polydactyly of Foot

Introduction

Extra digits of the toe 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 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   Prognosis natural history of disease may cause problems with shoe fitting and angular deformity of the toes

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

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