Case-control study of the treatment of postaxial polysyndactyly of the foot: Comparison of surgical results after removal of the fifth or sixth toe

Abstract

Background In postaxial polysyndactyly of the foot, the choice of which toe to excise is controversial. It is often treated by resection of the fifth toe to save the lateral neurovascular bundles of the sixth toe. However, the sixth toe is often short and laterally deviated, which may require wedge osteotomy, potentially shortening the phalanx and compromising circulation. This study outlines an individualized method to spare the length and axis of the fifth toe in polysyndactyly with a short and deviated sixth toe.Methods We retrospectively analyzed 38 patients who underwent surgery between 2006 and 2019. The fifth toe was spared in 18 cases, and the sixth toe in 20 cases. The ratios of the forefoot width, angle difference, and toe length were compared between the affected and unaffected sides postoperatively. Complications and subjective judgments on cosmetic results were recorded and compared.Results No significant between-group differences were observed for sex, age at surgery, or the follow-up period. The forefoot width ratio did not significantly differ between the groups. However, the angle difference and toe length ratios showed significantly better results in the fifth toe-spared group than in the sixth toe-spared group (P<0.05 and P<0.01, respectively). There were no cases of impaired circulation, and subjective evaluations revealed satisfactory results in the fifth toe-spared group.Conclusions In cases with short and deviated sixth toes, sparing the fifth toe is an effective method of cosmetic treatment. The surgical results were satisfactory, with an improved appearance and no residual deformities.

Plantar intermetatarsal perforator flap for first web skin‐graftless syndactyly release: Anatomical study and clinical application

“…The use of this flap resulted in excellent cosmetic results when applied in bilateral first web feet syndactyly, as the aims of a graft‐less technique and avoiding incisions in the dorsum of the foot were accomplished (Magdi, 1998; Nash et al, 2016; Niranjan et al, 2005; Woo et al, 2021). Our study demonstrated a solid anatomical evaluation with a rich vascular source for the plantar skin used.…”

“…The rationale for the use of a skin graft‐less technique in toe syndactyly release follow the same principles for syndactyly reconstruction in the hand: improving cosmesis by avoiding the use of skin graft and the use of dorsal incisions, and decreasing the risk of web creeping (Hikosaka et al, 2009; McCombe & Soldado, 2021; Say et al, 2021; Tian et al, 2017; Woo et al, 2021). Thus, we opted for the design of a plantar vascularized flap mimicking the one described in the palm by Soldado et al (McCombe & Soldado, 2021; Soldado et al, 2023).…”

Morphological Changes in Postaxial Polydactyly of the Foot: A Standardized Quantitative Analysis Using the Watanabe–Fujita Classification

“…For cases without syndactyly, lateral toe resection was preferred regardless of the involved ray. Corrective osteotomy of the proximal phalanx 12 was not routinely performed, even in patients with a laterally deviated proximal interphalangeal (PIP) joint. A longitudinal Kirschner wire was placed in patients with a large skin graft or skeletal reconstructive procedure.…”

Operative Management of Y-Shaped Metatarsal with Biphalangeal Sixth Toe

“…Pain, biomechanical problems of mobility and function, difficulty with footwear, sensitivity when walking, and aesthetic concerns are the factors that can influence the decision to undergo surgery (Figure 3). 9,13 …”

“…Critically, there is a lack of consensus on an ideal approach to surgical management. 8,9 This controversy is greatest when deciding on the appropriate age at which the patient should undergo surgery. 1 Despite this controversy, several authors have proposed different classifications of polydactyly malformation to facilitate management and surgical approach.…”