SLR - July 2017 - Jana Balas
A Clinical and Demographic Analysis
Reference: Kim JH, Kim BJ,
Kwon ST. Foot Syndactyly: A Clinical and Demographic Analysis. Archives of Plastic and Reconstructive
Surgery. 2016 November; 43(6).
Reviewed By: Jana Balas, DPM
Residency Program: MetroWest Medical
Center, Framingham, MA
Syndactyly of the foot is the second most common congenital foot anomaly.
Isolated foot syndactyly occur four times more frequently than isolated hand
syndactyly. However, despite its higher incidence, foot syndactyly has been
less frequently discussed in the literature, as compared with hand syndactyly.
This study presents a demographic analysis, clinical features, surgical
technique and postoperative outcomes of foot syndactyly. The technique used by
the surgeon in this study may be useful for foot and ankle specialists who
treat this condition.
Methods: This was a retrospective chart review of 118 patients (155 feet) treated by a single surgeon in the Department of Plastic and Reconstructive Surgery. During a 25-year period between January 1990 and December 2014, these patients all underwent surgical correction for foot syndactyly. Clinical features evaluated were partial or complete, simple or complex and unilateral or bilateral involvement. Functional outcome and postoperative complications, such as web creep, flexion contractures and angulation deformity, were assessed. The interdigital triangular flap was designed to reconstruct the web space with methods originally described by Cronin in 1956. The dorsal triangular skin flaps were marked from the point of the metatarsal head dimple to the interdigital crease. The triangle was designed such that the ratio of the height to the base was greater than 1.5 so that it could reach the plantar interdigital crease. A zig-zag incision was designed to place the tip of the triangle at the joint level. The remaining skin defect was then covered using a full-thickness skin graft (FTSG) harvested from the inguinal area. In cases of multiple web space involvement that required two or more operations, the next operation for the neighboring web space was delayed, with a mean interval of 9.5 months.
Results: Details of the
demographic and clinical findings are discussed. Of the 118 patients with
syndactyly (155 feet, 194 webs) who received surgery, only three patients developed
postoperative complications. These included misaligned web creep requiring
surgical revision, hypertrophic scar and a pressure sore of the heel that was
resolved with conservative management. In addition, six of the 118 patients were
referred from other hospitals due to secondary complications from syndactyly
correction. All of these secondary cases were successfully corrected by the
aforementioned surgical methods.
incidence of hand or foot syndactyly is known to be one in every 2,000 to 2,500,
which makes syndactyly the second most common
congenital limb malformation after polydactyly. Hand syndactyly frequently
occurs in the third interdigital web space, while foot syndactyly most
commonly occurs in the second interdigital web space. Isolated foot syndactyly
is known to be more frequent than isolated hand syndactyly. Despite this
higher incidence, there is less discussion of foot syndactyly in the
literature. Foot syndactyly surgery using a dorsal
skin flap and a sufficient FTSG may be necessary for better postoperative
outcomes and lower complication rates.