Polydactyly, a condition where a child is born with extra toes, can be both surprising and concerning for parents. This condition, while uncommon, is not unheard of, occurring in approximately 1 out of every 1,000 births. In this blog, we will explore what polydactyly is, its causes, how it’s diagnosed, and the treatment options available.

What is Polydactyly?

Polydactyly (pronounced pol-ee-DAK-til-ee) is a congenital condition characterized by the presence of more than five toes on the feet. The extra digit can range from a small, underdeveloped nubbin to a fully formed, functional toe. Polydactyly often includes additional bones in the foot that correspond to the extra toe, called the metatarsals. Likewise, the metatarsal may be small, partially formed bones, or full length metatarsals that articulate with the extra digit.

Polydactyly can be classified into three main types based on the location of the extra digit:

  • Preaxial Polydactyly: The extra toe is medial to or inside of the big toe.
  • Postaxial Polydactyly: The extra digit is on the little finger or little toe side. This is the most common form.
  • Central Polydactyly: The extra digit is located between the other fingers or toes that arises between the second through fourth toes.

Causes of Polydactyly

The development of extra digits occurs during fetal development. Polydactyly can be caused by genetic mutations and can run in families. It is often inherited in an autosomal dominant manner, meaning only one copy of the altered gene from one parent is sufficient to cause the condition in a child. However, it can also occur sporadically, with no previous family history.

Polydactyly can occur as an isolated condition or as part of a syndrome, such as Ellis-van Creveld syndrome or Bardet-Biedl syndrome.

Diagnosis of Polydactyly

Polydactyly is usually diagnosed at birth through a physical examination as extra toes can be seen on the feet. In some cases, it may be detected before birth via ultrasound. To understand the complexity of the condition, our podiatrists may perform additional tests.

To see the bones in the extra digit and assess its structure, we will take x-rays of the affected foot. X-rays are an important part of surgical planning to determine if and where an extra toe or bone should be resected.

In some cases, especially if there is a suspicion of an associated genetic syndrome, genetic testing may be recommended.

Treatment Options

Treatment for polydactyly depends on the form and functionality of the extra digit. In some cases, especially if the extra digit is small, rudimentary, and non-functional, it may be left alone.

Conservative treatment revolves around offloading and padding sites of increased pressure with orthotic devices. Shoes in a wide with and with a wide toe box are important to prevent pain with walking.

In many cases however, surgery is often considered the best option and is necessary achieve optical functional and cosmetic results.

The most common treatment is surgical removal of the extra digit and/or extra metatarsal. An extra digit that is partially formed or malformed will be selected for surgical removal. The timing of the surgery can vary, but it is often performed between ages 1 and 3 when the child can better tolerate anesthesia and the risk of complications is lower.

The timing of surgery also corresponds with the timing of shoe gear use. As children begin to walk, polydactyly can make fitting the foot into a shoe challenging, leading to pain and blister formation.

It is important to understand that no two polydactyly cases are the same, and the recommendations for surgery can vary greatly.

Post-surgical care includes monitoring for any complications, such as infection or issues with wound healing. A lower leg cast may be applied to protect the surgical site as it heals. Children may be required to remain non-weight bearing for part of their post-operative recovery period. Physical therapy is important to ensure proper function of the affected foot and a return to walking.

Living with Polydactyly

Most children with polydactyly lead healthy, normal lives, especially when the condition is addressed early. With proper podiatric care, the cosmetic and functional outcomes are generally excellent. It is important for parents to seek support and education about the condition, as understanding polydactyly can help in managing any challenges that may arise.

Conclusion

Polydactyly in children, while initially alarming, is a manageable condition. Advances in medical understanding and surgical techniques have made it possible to address the extra digits effectively. If your child is born with polydactyly, consult with our podiatrists to explore the best treatment options.

For more information or to schedule a consultation, please visit our clinic or contact us through our website.

At Bayshore Podiatry Center, we are dedicated to providing comprehensive care for children and adults alike. Our experienced team is here to support you every step of the way!

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