Congenital Deformities of the Foot & Ankle
Classification of macrodactyly
Isolated non progressive Growth rate of affected digit proportionate to growth rate of patient. Progressive macrodactyly Disproportionately faster growth rate of the involved part. More likely to involve more than one digit
The classifications of polydactyly
-Temtamy and McKusick (Preaxial (medial ray) (Postaxial (lateral ray) (Mixed forms (in middle, central ray)
treatment of macrodactyly
Amputation Reduce bulk Dorsal worm like shortening
Complications via syndactyly
Contracture of toes Neurovascular compromise Post operative defects Dehiscence
Conservative treatment of cleft foot
Custom molded shoes
Classification of syndactyly
Davis and German: Incomplete: Webbing does not extend to distal aspect of toes. Complete: Webbing extends to distal aspect of toes. Simple: Soft tissue alone Complicated: osseous involvement
Syndactyly
Definition: congenital or acquired deformity in which webbing persists between adjacent digits. Often involves 2nd and 3rd toes common in twins
Polydactyly
Definition: presence of one or more extra or supernumerary digits or metatarsals of the feet.
Etiology of polydactyly
Genetic 8-30% positive familial history No sex predilection Bilateral 25-50% of the time Incidence higher in black and Asian populations
What are some complications of polydactyly
Hallux varus Wider foot Residual tissue Osseous bulk Short 1st metatarsal
Surgical considerations of polydactyly
Non osseous deformities - excision when stable Rudimentary osseous deformities wait a few months Age range 3 mo - 13yrs Evaluation of central and metabolic illnesses Further studies Which metatarsal to remove Goals of surgery
Complications of macrodactyly
Poor/delayed wound healing Infection Neurovascular compromise Continued fatty disposition (fat wants to make that toe bigger) Prolonged edema
Treatment of underlapping toe
Taping/strapping Passive stretching/manipulation Syndactyly Skin plasty Tenotomy Arthroplasty Tendon transfer
Surgical treatment of cleft foot
Treat HAV and intractable plantar tylomas Cosmetic
Conservative treatment of polydactyly
Wide/deep shoes Padding Strapping Orthoses
COngential overlapping lesser toe
common condition in which one toe lies on the dorsal aspect of the adjacent toe. Most often seen in 5th toe Believed to be caused by prolonged malposition in utero Asymptomatic in 50% of patients
Cleft foot
congenital absence of two or three central rays or digits. Autosomal dominant trait with variable penetrance Often times bilateral
COngenital underlapping toe
one or more toes deviated plantarly, medially, and in a varus rotation under the adjacent toe. Congenital form of hammertoe Does not spontaneously correct
Macrodactyly
rare congenital deformity characterized by an increase in size of the elements or structures of the affected part including the bones, nerves, subcutaneous fat, nails, and skin. effects hands more than feet
What is the definitive treatment for syndactyly
surgery Curved or zig-zag incision Flaps Skin grafts Tissue expansion
One goal of surgery
to have plantargrade foot that you can ambulate with
