Extra digits (ulnar polydactyly) Finger Deformities

Extra Digits- What Happens After Treatment

Postaxial polydactyly is the medical term for an extra digit on the pinky side of the hand.  It is far and away the most common location for an extra digit.  It is much more commonly seen in African Americans compared to whites (the reverse is true with radial polydactyly– thumb side).  There is a definite inheritance pattern (typically autosomal dominant).  I have previously written about this on several occasions- read here. 

I find it interesting that most children with an extra finger next to the pinky are not treated by a hand surgeon.  The extra digits are routinely “tied- off” in the newborn nursery.  Rarely these children may be treated in the pediatrician’s office or at an orthopedic surgeon’s office.  And most of these kids do really well, although small signs of the extra digit remain years later.  However, this treatment is best for the small extra digit and not the fully formed digit which requires a more formal surgery.

There is a huge variety in how the extra finger may appear- from quite small to normally sized.  The position and development of the extra digit is also variable as noted in this excellent article in the medical literature.

This child has a fully formed extra digit next to his pinky.

Smaller (and a bit swollen) extra finger.

Another type of extra digit, this time coming off the small finger closer to the nail.

So, no matter whether the extra digits is “tied- off” in the newborn nursery, clipped in the clinic or treated with formal surgery, most patients do great. 


Subtle hint of where the extra digit was removed.

However problems do develop.

1) One potential problem with an extra digit procedure is the need for a later surgery, a formal surgery to address the scar or pain.  In a recent article on using clips in the clinic (see here), 7% of kids needed a scar revision surgery.  Here is an example of a child treated in the nursery with an uncomfortable residual “nubbin.”
Painful, small nubbin after treatment of polydactyly.

2) When the extra finger is clipped or tied, the blood supply to the digit is cut off and the extra digit enlarges, turns black and eventually falls off.  However, the timing of this process is unclear and the extra digit can stay on for week.  There is also a risk of infection.  These factors affect family satisfaction with this type of procedure and it certainly makes education of the family very important.

Necrotic extra digit after being tied off.

Another necrotic small finger polydactyly after being tied off.

3) Even formal surgery is not perfect for polydactyly.  The goal with formal surgery is to remove the finger and address the nerves, arteries, and tendons to allow a satisfactory appearance and function. And it is usually successful.  There are few problems reported.  Here is one recent example of a patient I treated with a revision excision.  His first surgery had been elsewhere and the surgeon had left behind some bone and the nerve stump had become painful as well.

After incomplete extra finger excision.  The patient needed a revision surgery.

Charles A. Goldfarb, MD
My Bio at Washington University


  1. Has anyone (or should I say any parent) ever wanted to keep the extra fully formed digit? Especially if it is not aesthetically offensive (such as the 1st photo)?
    I think it would be neat to have a normal looking extra digit, although it would be annoying having to buy custom made gloves!

    1. I am a mother of a 8 month old who doesn’t want to get it cut off. It’s been apart of him since he was born and it doesn’t cause him any harm. In the future he can decide if he wants to keep it or not. What if that’s his gift? Ya know?

      1. Jazzy,

        Thank you for writing. I understand that this can be challenging as a parent, especially with more developed fingers. In my experience, it is extraordinarily rare (I won’t say ‘never’ but probably close) that an extra finger is helpful. And, the extra finger often gets in the way with daily activities (especially as the child engages in more activities, school, etc). Certainly, others have wanted their child to participate in the decision but realize that it will be years before he/ she is ready. It can be 8-12 years of age, depending on your child. In my experience, making the decision early has many benefits.

        Good luck!

  2. Kelly,
    Thank you for the question. That has indeed happened in my practice (not often). But, as I recall, both patient came back early in their teenage years to request the surgery to remove the digit.

    This brings up an important question- when can a child make such a decision for himself/ herself (as some families wan this to be a decision for the child). And the answer, is likely older than we think. Teenage years most likely. So while I respect the wishes of all my parents, I do make sure they understand that if they want their child to make the decision on this (or anything, really), it will need to be in many years. For that reason, I discourage the 'waiting' whenever possible.

  3. What if the normal pinky next to the extra digit doesn't have a nail and is shorter? Can the surgeons transfer the nail from the extra digit to the real one?

  4. Hello,
    In this situation, both fingers are abnormal- making for a more complex situation. This is very unusual and I would certainly recommend seeing an experienced hand surgeon who regularly addresses this type of issue. We do not routinely transfer nails.

  5. When a suture is tied around the extra finger, it swells and then 'dies' without blood supply. It then falls off but can take 4-6 days and sometimes longer. Infections are rare although the digit goes through somewhat ugly phases in which it swells and changes color. I hope this helps.

  6. My nephew has an extra digit coming off his pinky. He has endured years of ridicule from classmates and is almost 15 now. He wants to have the finger removed but is scared of his functionality after the procedure. He is a very skilled drummer and dabbles with piano and guitar as well so losing function in his hand is a big deal. The pinky is sharing a joint with the extra finger and they move together. Do you any experience with this? Any advice would be helpful and much appreciated. Thanks in advance.

  7. Hello,
    I do have experience treating teenagers with extra digits. Typically, the family decided to wait and let the child decide. It does take time for a child to make this decision (your nephew is about the required age in my opinion), and it is an adjustment for a teenager (it is not for a young child when these are typically treated).
    While I cannot comment specifically about your nephew because so much depends on his specific situation, rest assured that I would expect him to do great and not lose function with this surgery. The key is to see a surgeon with experience! Good luck.

  8. Hi, can this fall off happen without the finger being tied? My baby has one and it is seemingly changing color at the base and seems to be causing some pain.

  9. Hello. It is difficult to answer your question but if there is limited blood supply to the small finger, it could 'auto- amputate'. While pain would be unusual, I would absolutely see a congenital (pediatric) hand surgeon. Good luck.

  10. Thank you for the question. I assume that this procedure was done by a medical professional who has experience with placing and tensioning the string. One of the challenges is knowing what is normal after this has been done- swelling, change in color are both common. I am not sure what "leaking" means but could be concerning and it probably makes sense to be seen by whomever placed the suture/ ligation. Good luck.

  11. Hi Charles if a baby is born with extra digits with bone on both hands and toes does it make the sugery and recovery more complicated.and how long does it usually take to heal?

  12. Larger extra digits may be more challenging to treat compared to simple 'nubbins' but there are many factors. The type of extra digit and the surgery required are the key factors for complexity of surgery and time to healing. Good luck.

  13. Hello, I was born with an extra digit (no bones or anything just skin) and my mom had it tied off in the hospital while I was born. However, it has formed into a "nubbin" or "neuroma" aka. a bump has formed into my pinky finger where it was tied off. How can I get this surgically removed? Or what procedure should I undergo and who should I contact (what kind of doctor). Please help me, I am 19 now and I always wanted this fully removed but I did not know how to proceed

  14. Thank you for this question. This is an important issue and one that is common. Sometimes the 'nubbin' is painless and sometimes there can be pain from the nerve. Either way, a relatively straightforward surgery can help. A hand surgeon can help, ideally one with experience with birth differences- someone who treats this type of issue commonly. Feel free to contact me offline by email if helpful.

  15. My daughter's was like photo #2. I wanted to keep hers but she got hair tangled around one and it started to die so i had them removed when she was about 6months old. She's now 12 and said that sometimes it hurts where her scar is. The doctors used a scalpel to remove hers not tie it. Why is she experiencing pain? My 2 brothers had the same both are adults now and said theirs hurt sometimes as well.

  16. Thankfully this is uncommon, but does happen. Typically, this is a neuroma- an inflammed nerve ending. When the digit was removed, the nerve to the digit was also cut. Sometimes it can be painful later. Surgery to remove the neuroma is well tolerated and with a relatively quick recovery. Obviously, if only a nuisance, she should ignore. But, if more problematic, there are solutions.

  17. My 3yr old had hers tied. And now she has a small nubbin. I Wonder if it will get bigger as she grows. She doesn't complain of pain yet

  18. Hello,

    I would hope that there will never be pain. The nubbin may get likely get slightly bigger but not dramatically so. Hopefully no additional treatment will be necessary.

    Good luck.

  19. Hello Jo,

    The suture choice depends a bit on the age of the child and the size of the extra digit. Typically, I use a 2'0 suture and I prefer a Vicryl suture (not a monofilament). One of the complications of this treatment is that a 'slick' suture can slip off and a suture like a Vicryl tends to stay in place (although can irritate). I hope that is helpful and, again, I consider size and suture for each child.

  20. I would recommend that your child be seen by a medical professional. Ideally, in my opinion, a hand surgeon who addresses this type of situation commonly or a pediatric orthopedic surgeon. I would not recommend ever addressing at home.

  21. A pediatrician said I could tie off the extra digit at home, being that it is only tissues. Is this safe?

  22. Thank you for the question. The answer really depends on the type of extra digit and the expectations. To be clear, the goal in "tying" off the extra digit is to prevent the blood supply and have the finger slowly turn black and fall off. In my practice and in our area, small extra digits can be tied off successfully but this depends on how thin the "stalk" of the extra finger is. This is usually done in the newborn nursery or in the hand surgeon office. Bigger extra fingers and wider stalks are harder to successfully tie off. First, you may not be able to limit the blood supply and second, even if successful, there may be a large bump and even pain. These may be treated surgically. It has not been my practice to have families do this at home (again, this is dependent on where you live/ what the normal treatment patterns are). Good luck

  23. hi, my baby had an extra digit fully formed and functional but was joined on bottom to his pinky. we had it removed recently by a professional and I'm wondering if you've ever seen a bump form in such a case. also is there anything we can do the scar should be minimal?

  24. Hello. Thank you for reaching out. Yes, I have seen bumps. This could be from extra skin or sometimes the nerve reacts to be cut (Required to remove the finger) by forming a neuroma (round ball at the end of the nerve). This can be painful at times (when bumped). Scar massage may help and, if painful, see the doctor who treated you (or a hand surgeon if not your original surgeon).

  25. Hi there, my son is now 15 and yet I still find myself with questions. He was born with a tiny pinky next to his pinky fingers on both sides. The dr tied them off. One fell off after about a week maybe 2 the other did not and I think it was about 5 weeks, when I accidentally knocked it while dressing him. My poor baby was screaming the most painful sound ever. I rushed him to the dr and th de sort of clipped it off. I remember it was like a thin bone .. slightly thicker than a hair.. that it seemed to be attached on. His has a nub there, looks like a wart and I know it still bothers him. Once in while he will hit it accidentally on something. I’m Wondering if it would be worth ya big an X-ray to see what is there? See if at some
    Point it would be helpful to remove what is left?

  26. Hello. Thank you. An x-ray might be helpful if there is bone there but often soft tissue (skin or scar) or a neuroma (enlarged nerve). The neuroma is perhaps most likely especially if painful when bumped. If it does seem to be a neuroma, a small surgery is typically curative. A hand surgeon would be ideal to assess this issue.

  27. Hello, my son was born with extra digits next to pinky like 2nd photo. Was recently tied off and one turned purple then red is this color changed a part of the process? The other is still turning darker.

  28. Hello 'ahippiequeen',
    Thanks for writing. First, of course, check with the physician or surgeon who did the typing off. But, the short answer is yes- this can be normal. It is actually why I don't love this process- families have to witness it. When I tied or staple an extra digit, I tend to just cover it up for a week. Good luck.

  29. My friends baby had her two digits tied off 10 days ago , each digit is brown not black … we are concerned that it hasn’t fallen off in the projected 9 days. Should we be worried ?

  30. It is not. For me (and surgeons may differ in opinions on timing), it really depends on the exact characteristics of the extra digit. If small and narrow "stalk" connecting it to pinky, still certainly ok to proceed.

  31. This is honestly why "tying- off" these fingers is not my favorite. We tend to just cover everything up to for two weeks b/c this picture does cause anxiety. The brown vs black does not sound overly concerning and it can take more time. But, obviously, touching base with the doctor is the best step. Good luck to your friend.

  32. Hello I just made another comment but I don’t know if it showed up.. however I have a son who is 2 he was born with the extra little finger next to his pinky ( my son is mixed white/African American) his pediatrician tied his little extra finger day 2 of him being born and it turned black and fell off.. now there is a bump where the little finger was at it almost looks like a little wart and I haven’t noticed it causing him any pain or anything like that.. actually the little lump is the reason I googled this in the first place.. I was just making sure it wasn’t trying to grow back or anything ( I wish I could take a picture to show what it looks like ) but I just read the comment above me congratulations to just having a little boy and I would say no it’s not to late for them to tie it off they did ours day 2 and had it tied off for about 3-4 days before it fell off!! Congratulations and good luck!! 🙂

  33. JessC,
    Thank you for the comment. This is extraordinarily common. That is, when a digit is 'tied-off', there is often a small nubbin or 'wart-like' bump left behind. Many times this is painless but sometimes it can be uncomfortable- this seems most common if there is an irritated nerve in the bump.

    Bottom line- a small bump after 'tying- off' a finger is common and typically well tolerated.

  34. Hello my son is 20 days old and was born with extra digits where they were just hanging from skin and he had his extra digits tied off but they left behind a huge lumps on both hands. How should I proceed on getting the lumps removed? Could I find a hand doctor that will just numb the area and scalpel it off? Or what to do I want it done before he gets to sucking on his hands and getting bigger. I don’t want him getting put to sleep to get them removed.

    1. Rae- congratulations on the birth of your son. I would be patient to allow this time to either calm down or declare itself fully. Give it at least 6 months because if it does not calm down, surgery would be safer at that age or older. This could be just extra skin or could be something more. I hope this helps.

  35. My son is currently 6 weeks and has its extra digit tied off on august 18th and it still hasn’t fallen off. Its dried up, black and dark. I left words with his dr and havent heard back yet. Is it normal for it to take this long to fall off?

    1. Hello Brit. I am sorry you have not heard back from your doctor. While I cannot speak to your son’s situation, in general, it can take several weeks for an extra digit to ‘fall off’ after being tied. Once the digit becomes dark, its just a matter of time. Occasionally, if the digit simply does not come off, a small, painless incision can be made to remove it. Good luck!

  36. My daughter is 3 and has an extra digit like image 2 and for the last 2 weeks she’s complained of pain and change in appearance of the digit and the stalk which was really thin is thicker and sore to touch. The dr said it looks like it’s starting to detach on its own and she is on antibiotics. She is in a lot of pain though and I want to know if It would be ok to ask to get it tied off now or should we just ride it out. The dr said it’s doing it’s thing thing naturally and we cna just give it another two weeks and it’ll fall off. I just cant watch her suffer like this anymore. Will it be painful to tie it? Can it cause any complications if it’s already starting to come off on its own?

    1. Maryam,

      Usually extra digits are not painful although if it has poor blood supply and is ‘starting to detach’, it could be uncomfortable. Certainly, tying it off is one option which might speed things along. Is she 3 years old?

      1. Yes she’s 3 years old and has been in pain since Christmas Eve. She got it caught in a coat hanger a couple days before and then the pain started. Dr initially said it’s infected but as it’s progressed it looks more blue and like it’s coming away from the stalk. It just really hurts her when anything touches it.

        1. Maryam,
          I must defer to your surgeon. The key consideration is assuring no infection. Color change is part of the process of the finger necrosing. Pain can be a part of this process but is typically short lived.

  37. Hi Dr. Goldfarb,

    I have a question regarding my newborn’s polydactyl on her pinky. It is attached by a thin stalk about a centimeter long. I noticed the root where the stalk meets her normal pinky is getting larger since she has been born. Her pediatrician wants to wait until two months old to xray to rule out bone before tying off. My concern is that if we wait that long it will continue to grow making the removal and healing process more difficult.
    Do you typically wait until a certain age to treat, or how do you decide when to remove? Does excision and cauterizing decrease risks of nubbins and neuromas forming compared to tying off?

    Thank you!

    1. Thank you for the question. To be clear, my response is best on general principles, not your newborn. But, if the preferred choice is to tie off the extra digit, the we often perform this procedure in the newborn nursery or at a first visit with us. We don’t typically obtain an x-ray as it does not change care. It is my belief that if the base is wide/ thick, tying it off will work but will typically leave a wart- like nubbin. Rarely uncomfortable but, as you mention, can be if irritated nerve is present. If I decide surgery makes sense, I wait until a time of anesthesia safety, typically 5 months or so. I have been happy with the appearance and functional results with the procedure.

  38. Hi Dr. Goldfarb

    My 3 and a half month old and has a finger similar to figure 2. We havea surgery scheduled for its removal this coming week via local anesthesia. Is it safe to have a surgery with anesthesia at this age as this was my primary concern, or should we wait. And second, is it common for nubbin or neuroma to develop after having the surgery in which it is cut off? If so how can it be prevented?

    Thank you.

    1. Kay,
      Local anesthesia for removal usually means an office- based procedure. The numbing medicine is injected and then the surgeon removes the extra digit but there are two factors which affect outcomes 1) the technique (sutures, staples, etc) and 2) the width the attachment of the nubbin to hand. Broader attachments often mean more of a residual nubbin. I believe this is a safe process and can be very effective. I would not expect a neuroma but it can happen (as can a residual nubbin/ wart appearance). IF these happen, a later surgery can resolve. Good luck.

  39. Hello,
    Concerned about my 2 and half year old who had finer ties off as a newborn. Up until recently we have had no problems with the little stubs left behind. Today he became aware of one and it looks like it may be peeling or maybe he hurt it playing. He isn’t crying or anything but he said it hurts. I covered it with a band aid and will be going into doctors office asap. But after he feel asleep I did rub it ti see if there was a reaction cause he says ow to stuff that is already healed often and he didn’t seem to move when I touched it. Even though we are gonna get it looked at im worried he may need surgery to remove the stub. We were okay with letting him make the choice is the future. Could it be like the X-Ray photo.

    1. Nells- thank you. And I am sorry he is having discomfort. Yes- this does seem like an irritated nerve in the small nub. There is no real testing- just an examination should provide enough information. If bothersome enough, a small surgery can resolve. And, unfortunately, it is difficult for a child to make a decision about surgery until they are older. Good luck.

  40. Hi,
    I’m from Africa, my niece had hers tied by my mother on day 3 of birth but the thread used in tying it was removed by itself and we told her not to tie it again but recently I noticed the digit is looking darker and swollen. Does it mean it going to fall off itself?

    1. Thank you for writing and congratulations on the birth of your niece. While I cannot know for certain, darkening and swelling often does occur as a digit loses its blood supply- it may well fall off.

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