summary Local Gigantism is a rare congenital or acquired condition that can be caused by neurofibromatosis, proteus syndrome, amyloidosis, or tumor and presents with enlargement of a digit. Diagnosis is made clinically with relative enlargement of one or more of the toes. Radiographs are helpful for surgical planning. Treatment is generally reconstruction or amputation if symptomatic or if leading to functional deficits. Epidemiology Incidence rare Etiology Pathophysiology congenital causes: neurofibromatosis proteus syndrome klippel-Trenaunay-Weber acquired causes: amyloidosis elephantiasis (filariasis) av malformation tumor acromegaly Physiology unknown Anatomy Growth plate consists of three principal layers: resting zone proliferative zone hypertrophic zone Presentation Symptoms pain Physical exam enlarged digit or limb Imaging Radiograhs needed for reconstruction or amputation planning Treatment Nonoperative observation monitor growth of affected region Operative epiphysiodesis vs. bony and soft-tissue reduction procedures indications individualized based on etiology, location of affected area, skeletal growth left, and severity amputation
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