Bilateral polydactyly of the foot: Surgical approach in the context of a familial congenital malformation based on gait function and foot aesthetics

Abstract

1. INTRODUCTION:
Polydactyly is a rare congenital foot condition characterized by the partial or complete presence of supernumerary toes. It is usually an isolated condition, but can be associated with other anomalies or be part of a syndrome. The duplication can be preaxial, involving the duplication of the first toe (15%); postaxial, affecting the fifth toe (80%), or central (affecting the second, third, and fourth toes, representing 5%). It can be divided into type A (developed toe) or type B (rudimentary toe). Polydactyly of the foot causes both functional and aesthetic abnormalities in the patient. Functional abnormalities include difficulty putting on shoes and occasional pain when walking.
2. CLINICAL CASE:
This is a case of bilateral postaxial polydactyly of the foot in three generations of the same family. Four patients (grandmother, aunt, mother, and son) aged 57, 39, 34, and 4 years were surgically treated. The grandmother had a duplication at the proximal phalanx, and the rest of the family had a duplication at the bilateral metatarsal level.
They were operated on from oldest to youngest after clinical and radiological evaluation. All surgeries were performed under neuraxial block, addressing both feet in the same surgical procedure. A zigzag dorsal incision was made along the fifth metatarsal, soft tissue dissection was performed until the duplicated bone structure was identified, and subsequent osteotomy was performed for bilateral supernumerary toe resection.

3. DISCUSSION:
During the treatment of polydactyly, the selection of the toe (medial or lateral) to be removed is one of the most important issues. The choice of which digit to remove should be determined by considering the site of origin, the state of fusion, and the axial alignment and aesthetics of the feet. The goal of postaxial polydactyly treatment is to achieve a well-supported foot with an adequate contour, compatible with the use of regular footwear and improved gait functionality. Ideally, treatment should be performed before the first year of age to avoid difficulties with footwear before starting to walk. However, in Mexico, there are still patients who did not receive surgical treatment during childhood and seek care for discomfort when walking and/or foot aesthetics.
4. CONCLUSIONS:
Postaxial polydactyly of the foot is one of the most common congenital malformations. A hereditary pattern is usually observed. The functional prognosis for patients with a history of bilateral polydactyly of the foot after surgical correction offers good results. They present pain relief during walking, footwear, improved aesthetic contour of the foot, and improved self-esteem. Scarring is minimal and imperceptible. Clinical, radiological, and surgical evaluation is appropriate to achieve good long-term results.