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