|Beitragstitel||Heptadactylia: An unusual case of foot central polydactyly.|
We described original case of heptadactylia of the foot. Polydactyly is a prevalent birth anomaly observed in 1/500 living birth and is characterized by supernumerary digital or metatarsal toes. Polydactyly is generally classified into three major groups: preaxial (medial ray, 15-17%), post axial (lateral ray, 80%) and central polydactyly (3-6%). The duplication may appear at the distal and middle phalanx or at the whole digit and metatarsal. Central polydactyly with duplication of the metatarsal is really unusual.
A non-ambulatory 11 months old girl presented with seven toes on his left foot. The right foot have normal appearance with a metatarsal arch measured at 44 mm of width at the level of the heads. On the left side, the metatarsal arch is measured at 53 mm. Heptadactyly was associated with elevatus and clinodactyly of third toe, hypoplasia of the second toe. At standing, there is a grip on the ground of all the toes except O3 which remains in elevatus. There is no other congenital deformity at the clinical exam. The supernumerary toes made it impossible for the child to wear standard shoes. Foot radiographs revelated the presence of seven complete rays. Every toe has phalanx and metatarsal ray.
Decision was made for surgical treatment and resection of the second and the third ray; the two most malaligned toes in our consideration. We perform an interdigital incision on dorsal approach of the foot. We reconstructed intermetatarsal ligament of the first and the fourth metatarsal using sutures on the ligament and a K-wire to stabilize the foot. Then we make bandage lightly with cotton roll, and we applied a complete plaster of Paris cast to reduce the mobility of the reconstructed interdigital ligament. We removed the plaster and the k-wire after 4 weeks of non-weight bearing. An orthosis was then introduced. The patient proceeded to heal unremarkably, and at 2 months postoperatively, she displayed a well-healed postoperative scar and no evidence of any complications related to the surgery. A harmonious toe's cascade was restored.
We demonstrate that management of polydactyly of the foot requires careful preoperative assessment, including radiographs and photography. A good clinical exam in evaluating medial polydactyly improves type-specific description, which may, enhance the evaluation of surgical treatment. We recommend that surgical treatment be planned in childhood before the age of walking.