Polymetatarsia of the Foot without Polydactyly

Abstract

Case: We report a rare case of polymetatarsia without polydactyly. Our patient presented with pain and difficulty with shoewear. Radiographs showed an accessory metatarsal arising from the lateral aspect of the fourth metatarsal proximal metaphysis, fusing distally with the medial aspect of the fifth metatarsal head to form a single metatarsophalangeal joint. He was treated with a chevron osteotomy of the conjoined complex and an Akins osteotomy of the fifth proximal phalanx. Our patient recovered functionally, and his pain improved postoperatively. Conclusion: The chevron osteotomy is an option for treating polymetatarsia without polydactyly with the aim of reducing the forefoot width. Level of Evidence: Case study, level 5.

Operative Management of Y-Shaped Metatarsal with Biphalangeal Sixth Toe

“…Oragui et al 21 described the case of a 17-year-old girl with an extrametatarsal head with a duplicated fusion of the proximal phalanx, and Han et al 18 reported a case of polydactyly of the fourth metatarsal treated by bone transfer of the extrametatarsal bone and subsequent fixation with an internal plate. But polydactyly is not always visible, as reported in a case of polymetatarsia or metatarsal duplication associated with nonvisible polydactyly 25 …”

“…There exists a paucity of guidelines on the surgical management of polymetatarsia. 25 The presentation of postaxial polydactyly is very varied and may require different treatment modalities.…”

“…The main findings of this review are that the clinical and surgical conditions of polydactyly with and without polymetatarsia require different treatment, and surgical treatment must be personalized. There exists a paucity of guidelines on the surgical management of polymetatarsia 25 . The presentation of postaxial polydactyly is very varied and may require different treatment modalities.…”

“…But polydactyly is not always visible, as reported in a case of polymetatarsia or metatarsal duplication associated with nonvisible polydactyly. 25 Most of the literature agrees that the most frequent type of polydactyly is unilateral postaxial polydactyly, except for those cases associated with a family history, which is usually bilateral. However, polydactyly is often coincident with other diseases or genetic syndromes.…”