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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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