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syndactaly

AUTHOR: Marc Mitnick DPM

REVIEWED BY: Podiatric Medical Review Board

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webbed toes

WHAT IS SYNDACTALY

Webbing of the fingers and toes is called syndactaly. It refers to the connection of two or more fingers or toes. Webbing usually only involves a skin connection between the two areas, but in rare cases may involve the fusion of bones. This is known as simple vs. complex webbing. What occurs here is a failure of two or more adjacent digits to fully segmentalize during development.

Webbing occurs once in every 2000-2500 births and is three times more common in males than females. Webbing may be discovered during an examination of an infant or child. In its most common form, it is seen as webbing between the 2nd and 3rd toes. This form is often inherited and is not unusual.

Syndactyly can also occur along with other birth defects involving the skull, face, and bones. In fact webbing of the toes may be associated with over 300 syndromes.

The web connections usually run up to the first joint of the finger or toe, but may run the entire length. Bilateral involvement is found in 50% of patients.

"Polysyndactyly" describes both webbing and the presence of an extra number of fingers or toes. The "location" of the extra digit goes a long way in determining treatment, if treatment is necessary.

In the foot three types of webbing are seen.

Type 1 (zygodactyly), partial or complete webbing of the second and third toes; hands may also be affected.

Type 2 (synpolydactyly), syndactyly of the lateral two toes and polydactaly of the fifth toe in the syndactyly web.

Type 3, associated with metatarsal fusion.

TREATMENT FOR SYNDACTALY

Surgical intervention for simple syndactaly of the foot is rarely indicated as the webbing causes minimal loss of function of the toes, it is more of an issue with the fingers. Perhaps the number one reason for surgical intervention is cosmetic disapproval by the patient, rather than loss of function, at least in the foot.

Simple syndactaly involves skin grafts to separate the toes. If the two adjacent bones are fused separation becomes more difficult because many times there is only a single tendon and vascular system supplying the two toes and once separated obviously the two toes would no longer be able to share the tendon and blood supply.

In instances where you have a polydactyly (extra digit), if it occurs on the medial or lateral side of the foot, then amputation of the extra digit is the treatment of choice, assuming once again the extra digit does not share a common blood supply with the adjacent digit.

In patients that exhibit central polydactyly where the extra digit is in the middle of the foot, it becomes more difficult to determine which digit to surgically remove. However, removing the extra "inside" digit does not narrow the foot in any way and reconstruction of the middle of the foot in a cosmetically acceptable fashion can be very difficult.

REFERENCES

National Institutes of Health

Children's Hospital of Philadelphia

Seattle Children's Hospital

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Fla.

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New York

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Memphis, TN

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Scotland

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(location unknown)

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LH

(location unknown)

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Joe

(location unknown)

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(location unknown)

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Denison, TX

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Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,

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Texas

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UK

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Dear Dr.Mitnick

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Regards,

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Mansfield Ctr, CT

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Placentia, California

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Unknown

Unknown location

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I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

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Unknown location

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Pacific Grove, CA

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Anonymous

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Anonymous

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New Zealand

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Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

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Arizona

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Thanks, Kathy

Florida

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1st of all THANKS A LOT for your great site......

Anna

Poland

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M P

South Carolina

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unknown location

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...Thanks for your fantastic service.

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Arlington, VA

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Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

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San Clemente, CA

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Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!

Pam

location unknown

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Great insights! Thanks Doc, you're the best.

Glen

location unknown

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Bre

location unknown

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Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous

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Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous

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Poland

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Seattle, WA

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New Jersey

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Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

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Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!

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Evansville, IA

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Dear Marc

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San Diego, CA

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Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY

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Jill S.

location unknown

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THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS

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thanks again, this site is very helpful.

mark

Boston, MA

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Colorado

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Colorado

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Wonderful advice

by: Anonymous

This is the best site for foot problem info.

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Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown

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Canada

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location unknown

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Wisconsin

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location unknown

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North Carolina

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Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown

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Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida

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Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown

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New Jersey

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Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown

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I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

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Lenoir, NC

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Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA

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I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown

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