Polydactyl is a deformity present at birth, when the baby is born with extra fingers or toes. It usually occurs in single duplication, meaning just one extra digit.
Associated anomalies include duplications bilaterally (both feet) in 40-50% of patients, but often duplications are not symmetrical. Syndactyl (webbing) of the toes occurs in 1/5 of patients, and Down's Syndrome is present in a minority of patients. Only 30% of patients will have a positive family history of polydactyl.
It occurs in 1 to 2 of 1,000 births, in 0.3 to 1.3 of 1,000 caucasian births, and 4 of 1,000 black births, and males more than females.
Polydactyl occurs when the body follows a different set of directions when forming the feet during development. Researchers are still learning about the genes that cause polydactyl. It may be caused by an associated syndrome, like Greig Cephalopolysyndactyly Syndrome (GCPS) or Bardet-Biedl Syndrome (BBS).
Extra digits are often poorly developed and attached by a small stalk, generally on the little toe. Some are well-formed and may even function. Poorly formed digits are usually removed. If there are no bones in the toe, tying a string around it will cause the toe to fall off over time.
In older patients, the main complaint is difficulty with shoe gear.
Treatment of polydactyl is typically surgery, which excises the toe, providing the toe with the most normal contour, to facilitate shoe wear. Typically the most lateral toe is excised, depending on whether the deformity is pre or post axial. Pre-axial means the extra toe is adjacent to the big toe, while post-axial means they are adjacent to the pinky toe. Most surgeons will recommend surgery after 1 year, to reduce aesthetic risks, and prior to walking, allowing for the greatest potential for remodeling. Patients are often referred in at ages 4 or 5 because of difficulty with shoe wear.
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