The use of the Tsuge procedure for pedal macrodactyly

Abstract

Pedal macrodactyly is a rare clinical entity that poses a challenge to practicing pediatric orthopedic surgeons. Many treatment options have been proposed. In 1967, Kenya Tsuge proposed a method to decrease the length, width, and circumference of a macrodactylous digit, while maintaining the cosmetic benefit of keeping the nail. We retrospectively reviewed our experience with using this technique in four children (six toes) over a 4-year period. The surgery is described and our results reviewed. We believe that the Tsuge procedure is a technically feasible, effective, single-stage reconstructive technique for pedal macrodactyly that pediatric orthopedic surgeons should have in their armamentarium.

Macrodactyly of the foot resulting from plantar nerve impairment

“…17 , 20 , 22 , 25 Notwithstanding the uncontrolled growth resulting from nerve impairment, 26 more subtle pathologic changes in the plantar nerve may be responsible for the lower incidence of nerve enlargement in macrodactyly of the foot compared to that in the hand. 10 Schwann cells synthesize myelin. The Schwann cell marker S100 was absent in some areas of affected plantar nerves in our cases, implying that there were fewer myelinated nerve fibers.…”

“…[2][3][4] While hypertrophy and tortuosity of the digital nerve is prominent in macrodactyly of the hand, [3][4][5][6] digital nerve involvement is rarely seen in the foot; 7 , 8 digital nerve hypertrophy has been reported in two cases 9 and tortuous digital nerve in one case of macrodactyly of the toes. 10 Most previous studies on macrodactyly of the foot have focused on the digital nerves of the toes, while the plantar nerve-that is nerve trunk of the plantar aspect, has largely been ignored. Besides the toes, the corresponding forefoot is affected in most cases of pedal macrodactyly, 7 , 8 , 11 , 12 which is suggestive of nerve trunk disease.…”