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.
