The treatment of extra toes and toe syndactyly often involves the hand surgeon given the overlap in treatment strategies between hand and foot. As I have previously blogged, I typically avoid reconstructing toe syndactyly unless it involves the first web space (ie, the great toe). While there are exceptions to this approach, the risks of syndactyly reconstruction include infection and recurrence of the skin attachment (ie, web creep). Toe polydactyly can be on the outside of the foot (post axial) or on the inside of the foot (pre axial). Many times, the treatment of the post axial polydactyly is excision of the extra toe to allow normal foot wear with normal foot width. With pre axial polydactyly, the goal of treatment is alignment of the big toe (ie, avoid deviation) and independence of the toe to allow normal walking and running.
This 6 year old patient was treated in a staged fashion. While we all prefer treatment at a single time, operating on both sides of the fingers or toes can carry extra risk and so we often avoid it. In this case we corrected the right foot with a focus on the polydactyly (extra digit) and did not address the syndactyly between the first and second toes. On the left foot, we only addressed the syndactyly by deepening the web between the first and second toes.
The left foot was less affected and was treated with soft tissue reconstruction only.
The patient returned 14 months after the first surgery for a second, planned surgery on the right foot. In this surgery, the first web space on the right foot was deepened using full thickness skin graft from the top of the foot. These pictures give followup from the first surgery. There is also excellent alignment of both toes, both feet. The syndactyly reconstruction on the left foot has healed well.
I was the only one out of 6 born with polydactyly very similar to the pictures above.
As for my own children, only one out of my five were born with the same condition.
(All the same father)
Would that mean it could be a dominant gene?
Denise,
Thank you for the question. Many varieties of polydactyly, whether toe or finger, are indeed autosomal dominant. As you are likely aware, this means that 50% of children of a parent with the characteristic will have it as well. In this case, the other parent’s genetic makeup does not matter. In your family, the polydactyly is not likely to be autosomal dominant. There are many possible variations including autosomal dominant with variable expressivity and incomplete penetrance. Or, this could potentially be a sex- linked trait. Or, less likely, it could be autosomal recessive. The bottom line is that I cannot predict in this case the specific gene issue and inheritance pattern. Thank you.