Macrodactyly of Lower Limbs-an Update

Natarajan, Mariappan; Dhua, Subha; Garg, Cheena

doi:10.14260/jemds/2016/871

Cited by 5 publications

(11 citation statements)

References 22 publications

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“…Pedal macrodactyly mostly involved the progressive type in other studies (Table 1 ); however, static type preponderance in this study might be on account of our large cohort of cases which revealed the natural growth feature of the entities. Another reason was that disproportionate progressive overgrowth of toes frequently started from the age of 2 years onward [ 15 ] or early childhood [ 2 , 16 ], but patients under 2 years old in the static type group accounted for 45% ( n = 48) cases. Therefore, it is likely that a few “real” progressive type cases may not have presented in a timely manner.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 107 patients with macrodactyly of the foot underwent surgical treatment at our hospital between March 2011 and May 2020. Patients with diagnoses of other known overgrowth syndromes or otherwise uncharacterized syndromic presentations of lower extremity enlargement were excluded, such as Klippel–Trenaunay syndrome, Proteus syndrome, CLOVES syndrome, Ollier’s disease, Maffucci syndrome, Milroy’s disease, neurofibromatosis, and vascular anomalies [ 2 ]. Therefore, 93 patients with isolated macrodactyly of the foot were included in this study.…”

Section: Methodsmentioning

confidence: 99%

“…Macrodactyly of the foot is an uncommon congenital malformation characterized by enlargement of soft tissue and osseous elements of the foot [ 1 ] which causes many problems such as pain, calluses, ulcer, difficulty in wearing shoes, impairment in ambulatory ability and gait development, esthetic problem, and psychological issues [ 2 ]. However, the features of the clinical entity, usually reported in case reports or small case series owing to its rarity with an incidence of 1/18000 [ 3 ], are incomplete and obscure; thus, different or even contradictory results delineating the characteristics of the entities have been reported (Table 1 ).…”

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics of 93 cases of isolated macrodactyly of the foot in children

et al. 2021

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Background The purpose of this study was to describe the clinical characteristics of macrodactyly of the foot through a large cohort of cases to further understand this rare entity. Methods Medical records, clinical photographs, plain radiographs, pathological findings, and intraoperative photographs of 95 feet of 93 patients were reviewed. Data including age; sex; laterality; ethnicity; birthplace; family history; and history of gestation, environment, whether smoking, or drinking during pregnancy were collected and analyzed. Results Female patients (60%), left foot (56%), and static overgrowth (63%) were more prominent in the study cohort. Southern provinces (74%) and Han Chinese ethnicity (95%) predominated in terms of geographical region and demographic distribution, respectively. Multiple-toe involvement was 2.01-times more frequent than single-toe involvement. All five toes were involved with midline toes being most frequently affected overall and a medial distribution being more common than a lateral one. The forefoot was affected in 90 feet. The affected areas (toes and forefeet) were mostly located in the innervation of the affected medial plantar nerve (91%). The nerves showed enlargement in 49 feet, fatty infiltration in 25, a tortuous course in one, and were normal in 10 feet. Only six feet involved the musculature. Enlargement of phalanges and metatarsals were observed in 92 and 57 feet, respectively, and advanced bone maturation was seen in 63 feet. Twenty-two cases had syndactyly. Conclusions Macrodactyly of the foot is a rare congenital malformation with diverse clinical manifestations and multiple elements’ involvement. It also presents the characteristics of nerve-mediated overgrowth and “nerve territory-oriented” deformity similar to that of macrodactyly of the hand.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical characteristics of 93 cases of isolated macrodactyly of the foot in children

et al. 2021

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“…Few surgical principles must be followed when planning a soft tissue debulking procedure: mid-lateral incision along the digits are preferred, when crossing creases extend as zigzag incisions onto the glabrous skin (to avoid scar contracture), nerve excision can be done as it limits nerve tissue-induced overgrowth, always debulk one side of a digit at a time with proper visualization and preservation of the digital artery, wait for at least three months to debulk the opposite half of the same digit, epiphysiodesis is recommended once the digit approaches the size of the same digit in the parent of the same sex, perform corrective osteotomy for angular deformity at the time of epiphysiodesis, and downsizing of the nail plate and bed is important to achieve a better cosmetic outcome [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…Complications reported after surgery include wound dehiscence, infection, prolonged edema, ischemia of wound margins, sensory disturbances, recurrence/regrowth, scar contracture, joint stiffness, and keloid formation. Tolerton et al have recommended methotrexate therapy to suppress keloid formation and to control recurrence after surgical revision for keloid [ 4 , 8 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Isolated Acquired Macrodactyly of the Left Fourth Toe

Alexander

Kazzaz

Schenker

2021

Cureus

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Macrodactyly is a rare congenital disorder affecting the digits of hands and feet. It is often distressing for both parents and children. Surgical options range from soft tissue debulking with or without osteotomy and physeal arrest to simple or ray amputation. Although amputation is generally reserved for the severe progressive variant of macrodactyly and revision surgery, there is controversy regarding whether initial amputation or debulking is the best approach. We present a case of isolated macrodactyly of a minor toe, where debulking showed superior results.

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Amputation of left foot macrodactyly improve quality of life for a toddler: a case report from Tigray, Northern Ethiopia

Haftu,

Gebrekidan,

Gebrehiwot

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction and importance: Macrodactyly is an uncommon, not inherited congenital malformation of the digit with unknown prevalence and path of pathogenesis. The condition was described in 1940 and since then 107 cases were reported. Manifestations may mislead the diagnosis of hemangiomas and lymphangiomatosis. There are different options for treatment without a clear consensus. The authors are presenting a macrodactyly case that improved the quality of his life after he underwent surgical amputation of the toes. Case presentation: The authors had a case of a 2-year and 4-month-old male child presented with progressive growth of the left foot toes; which started since birth in the 4th toe and then involved 3rd and 5th toe later; resulting in deformity and difficulty in wearing shoes. Physical examination; showed left foot enlargements of the 3rd–5th toes. X-ray of the left foot was done he was diagnosed to have macrodactyly. Under general anesthesia metatarsophalangeal joint of the 4th–5th toe and distal interphalangeal joint of the 3rd toe, disarticulation was done. The patient is doing okay on follow-up for the last year. Clinical discussion: Consistently with other case reports from Korea, Tanzania, and Congo our patient presented with a primary type of left foot macrodactyly in his early life, and he was successfully managed with amputation of the affected digits. Conclusion: This is one of the rare cases which needs a high index of suspicion to diagnose and treat early to improve quality of life. Amputation is the most important management in resources limited areas.

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Macrodactyly of Lower Limbs-an Update

Cited by 5 publications

References 22 publications

Clinical characteristics of 93 cases of isolated macrodactyly of the foot in children

Clinical characteristics of 93 cases of isolated macrodactyly of the foot in children

Isolated Acquired Macrodactyly of the Left Fourth Toe

Amputation of left foot macrodactyly improve quality of life for a toddler: a case report from Tigray, Northern Ethiopia

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