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Introduction
  • Congenital absence of one or more toes
  • Epidemiology
    • incidence
      • less common than polydactyly
    • body location
      • lateral rays are affected more often than the hallux
  • Pathophysiology 
    • pathoanatomy
      • due to improper differentiation of the apical ectodermal ridge during development
    • thought to be caused by
      • teratogenic insults
      • impaired blood flow
      • amniotic bands 
  • Genetics
    • positive family history in some cases
    • sporadic in others
  • Associated conditions
    • orthopaedic
      • fibular hemimelia
      • tarsal coalition 
      • hand & foot abnormalities
        • polydactyly 
        • syndactyly 
        • constriction rings 
        • brachdactyly
    • medical
      • associated with a number of syndromes including
        • VACTERL
        • Fanconi
Presentation
  • Physical exam
    • absent digits 
  • Symptoms
    • usually painless
    • may present with discomfort during shoe wear
Imaging
  • Radiographs 
    • recommended views 
      • AP of the foot
Treatment
  • Nonoperative
    • observation alone
      • indications
        • mainstay of treatment as there is usually no limitation in function
 

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