Surgical treatment of polydactyly of the foot

Twenty-eight patients with polydactyly of the foot, involving 36 duplicated toes, were treated at the Tri-Services General Hospital during the past 7 years (1988 to 1994). They were studied regarding the incidence, location and methods of treatment. Twenty-two of the cases were unilateral polydactyly foot (78.6%) and 6 (21.4%) were bilateral. Of the unilateral group, 17 patients (77.4%) demonstrated a significant fifth toe duplication (p < 0.05, by One-sample Kolmogorov-Smirnov test) when compared to other toe rays. Surgical intervention was undertaken in 27 cases for removal of 35 duplicated toes when the patient was first seen, to allow maximum time for remodeling the foot postoperatively. In the preaxial group, the tibial side toe was removed with disarticulation, trimming of wide metatarsal head, capsular repair and re-insertion of abductor, flexor and extensor hallucis tendons. The removal of central ray duplication involved a dorsal racquet-shaped incision at the base of the duplication and re-approximation of the intermetatarsal ligament. Surgery for postaxial duplication involved excision of the most lateral toe in the majority of cases. Only 22 cases could be followed and evaluated for an average 2.4 years follow-up time. Twenty of the operated patients showed satisfactory result with acceptable outlook and normal, pain-free gait. Ten of the cases (35.7%) with polydactyly foot had developed 12 associated anomalies, and foot syndactyly was the most seen in this series. The delivery of surgery to correct the polydactyly of the foot in early childhood should be considered individually, depending upon the deformity. Surgery for the associated anomaly is according to patient needs and preference.