New Classification of Polydactyly of the Foot on the Basis of Syndactylism, Axis Deviation and Metatarsal Extent of Extra-Digit

Abstract

Background Polydactyly of the foot is one of the most frequent anomalies of the limbs. However, most classification systems are based solely on morphology and tend to be inaccu rate and less relevant to surgical methods and results. The purpose of this study is to present our new classification of polydactyly of the foot, which can serve as a predictor of treatment and prognosis. Methods To find a correlation between the various morphologic traits of polydactyly of the foot and the treatment plan and outcomes, we reviewed 532 cases of polydactyly of the foot in 431 patients treated in our hospital, expanding on our previous study that described polydactyly based on the importance of metatarsal bone status and varus deformity. The records of patients were evaluated and compared with previous studies at other centers. Results Unsatisfactory results were seen in 36 cases, which included 5 cases of incomplete separation due to syndactylism, 23 cases of axis deviation, and 8 cases of remnants of extra digit metatarsal bones. The locus of the polydactyly, or the digit which was involved, did not seem to affect the final postoperative outcomes in our study. Three factors syndactylism, axis deviation, and metatarsal extension are the major factors related to treatment strategy and prognosis. Therefore, we developed a new classification system using three characters (S, A, M) followed by three groups (0, 1, 2), to describe the complexity of polydactyly of the foot, such as S1A2M2. Conclusions Our new classification could provide a communicable description to help deter mine the surgical plan and predict outcomes.

Hexadactyly, A Rare Case

“…prognosis varies greatly [5]. Rarely have been described in the literature a hexadactyly of all four arts.…”

“…Bilateral form displayed the highest frequency of associated congenital defects. [4] These deformities can occur in many varieties, from a simple extension of a distal phalanx, involving carpal or tarsal bones, to a simple or multiple duplications [8].…”

“…In a Mexican retrospective case-control study the prevalence among 26,670 births was 1.73 in 1,000 live newborns. Instead in Chile, the prevalence has been estimated as 1.33 in 1,000 live newborns [5]. We describe a rare case of sporadic familial postaxial hexadactyly of all four limbs (Figure 1).…”

Current Classifications of Syndactyly and A Case Report

“…Sindaktili 300'den fazla herediter sendroma eşlik edebileceği gibi izole olarak da gözlenebilir (5). F-sendromu, Apert sendromu, Seathre-Chotezen sendromu gibi sendromların parçası olabilen ya da izole olarak çok farklı prezantasyonlarda görülebilen sindaktilinin bu durumu, sınıflama güçlüklerini de beraberinde getirmiştir (2).…”

“…Estetik ve fonksiyonel olumsuz sonuçları olan embriyolojik bir anomalidir (1). İkibin canlı doğumda bir görülme oranı ile konjential el deformiteleri içerisinde en sık rastlanılan ve gestasyonel 7 ve 8. haftalarda apendiküler apoptoz bozukluğu sonucu oluşan yumuşak doku ve kemiklerdeki füzyon bozukluğunun olduğu bir deformitedir (2). Sıklıkla otozomal dominant kalıtım göstermesine karşın, literatürde %60'a varan oranlarda sporadik olgularda bildirilmiştir.…”