Polydactyly


What Is An Extra Toe (Polydactyly)?

An extra toe (or digit) is medically known as polydactly or a supernumerary toe.  It is a genetic condition resulting where the digit is duplicated, and can be fully functional or just fleshy.  It may occur in the hands as well as the feet, and may involve both feet/hands.  The highest number of digits ever reported was in 2010, on Akshat Saxena (from India) with a total of 34 digits (10 on each foot/ 7 on each hand).  In the foot, it is more common to have an extra toe on the outside of the foot, and this is termed postaxial polydactyly.

Polydactly_Reconstruction_DrBlitz

Symptoms Of An Extra Toe

An extra toe(s) can be quite problematic for patients.  The duplicated digit(s) may make fitting shoes quite difficult (or impossible) because it typically adds width to the foot.  Patients can develop corns and calluses in pressure spots which may be painful.  Additional toes that are fleshy and not functional can be bothersome as they tend to get caught on things, and even make putting on socks difficult.  Patients with extra toes tend to be embarrassed of their feet, and affects children and young adults the most. Patients with hand involvement as well seem to be better adjusted to their condition overall.

Causes of Polydactyly

Polydactyly is genetic and may be associated with several syndromes, so a genetic evaluation is recommended.

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When to Seek Extra Toe Treatment

Common reasons patients seek treatment for brachymetatarsia are:
•    Pain
•    Interference with walking/activities
•    Difficulty fitting shoes
•    Unsightly appearance
•    Psychologically embarrassing

Non-operative Treatments for Short toe

Non-surgical methods for brachymetatarsia are aimed at decreasing symptoms (i.e., pain and/or calluses).

Simple treatments patients can do are:

•    Wear supportive shoes
•    Use an arch support
•    Wear shoes with a wide toe box
•    Modify activities
•    Spot stretch shoes

Non-surgical treatments Dr. Blitz can add:

•    Anti-inflammatory Medicines: Prescription strength medicines to decrease pain and inflammation.
•    Custom Foot Orthotics: Dr. Blitz creates am orthotic with an exact mold of your foot to better align and support the foot to ease current discomfort.
•    Splints or Pads: Specific pads may prevent pressure and physical irritation in shoes.

Polydactyly Reconstruction Surgery in the Foot

Depending on the toe involved and severity there are various approaches to fixing the problem.  Simply, the extra digit(s) needs to be removed.  Each case, however is different because not all supernumerary digits are functional and there is a varying presentation. In some cases just a portion of the toe is duplicated, and in others the entire toe will be duplicated along with the bone that it connects it to the foot (called the metatarsal).  The metatarsal can be completely duplicated but more commonly a two toes will share a single metatarsal bone.   A common solution is removing the outermost toe the portion of bone that it is associated with.

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Polydactyly Surgery Recovery

Recovery after Polydactyly surgery generally depends on the method of surgery performed, but a majority of surgery is considered more amputation-like surgery.  For simple soft tissue surgery healing time is often 2-3 weeks, and when bone work is needed healing time can be  6-8 weeks.

Walking After Polydactyly Surgery

Walking after extra toe surgery is commonly allowed, but depends on the extent or complexity of the surgery.  Simple amputation surgeries are walking.  Major soft tissue surgery involving skin flaps is a different scenario altogether and walking may not be allowed for several weeks, especially if bone cuts were performed.

What Anesthesia Is Needed For Polydactyly Surgery?

Most cases of polydactyly surgery in the foot are performed as outpatient surgery- this allows patients to go home the same day.  Again, extensive procedures may require a hospital stay.  Depending on the extent of the reconstruction, it can be performed under a local, regional, spinal or general anesthetic.

Is Hardware Implanted with Foot Polydactyly Surgery?

Surgical hardware may not be necessary with a foot polydactly reconstruction.  If bone cuts are performed to re-angulate a bone, then screws and/or plates may be used.  Depending on the polydactyly reconstruction, some of the hardware is permanent.

What Are The Risks Of Polydactyly Foot Surgery

There are general risks of polydactyly surgery (or any surgery) and the use of anesthesia. Complications may occur and are not necessarily your fault, or the fault of your surgeon. Nonetheless, you should understand the risks.

Polydactyly foot surgery complications include, but are not limited to: infection, pain (temporary or permanent), swelling, hematoma, bleeding, blood clot, poor wound healing, incision breakdown, poor bone healing (delayed union, nonunion), malunion, nerve injury, disability, recurrence, hallux varus, metatarsalgia, unsightly scar, stiffness, loss of function, abnormal appearance of foot, weakness in toes, loss of toes, hardware problems, need for revisional surgery, and/or catastrophic loss.

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