Tolgay Satana and Fulya Doktorlar*

Clinic of Orthopaedic, Turkey

*Corresponding Author: Fulya Doktorlar, Clinic of Orthopaedic, Turkey.

Received: March 28, 2022; Published: July 26, 2022

Abstract

Introduction: Congenital polydactyly is an autosomal dominant deformity inherited by one generation from anotherd the most commonly cited classification scheme by Wessel which, does not include this particular anomaly (tarsal coalition). In addition, there has been only reference to this type of polydactyly with coalition in hand in the literature. We could classify our case in main type VI but propose subdivision A- not tarsal coalition B-With tarsal coalition.

Medial finger might be halluxs even if it is hypoplastic, may disrupt the plantigrade structure of the foot and cause ulcers in the plantar region caused by pressure changes. Tarsal coalitions are frequently seen in preaxial.

Material and Method: The patient was admitted to the outpatient clinic with a complaint of inability to put on shoes. His both feet had six toes each. In his radiological examination, extra second digit sprouting from preaxial, arising from medial cuneiform and hallux varus deformity were found in medial. Duplicated thumbs are almost similar, medial thumb was smaller or hipoplastic. Medial finger decided to as Hallux after radiologic and functional investigation.

The treatment is planed that second digit ray amputation and residual hallux varus deformation realigned to normal anatomic relationship with medial cuneiform open wedge osteotomy while the 1^st intermatatarsal Linsfranc joint relation was restored. Supero-lateral part of medial cuneiform was continue second digit metatarsal bone than ray amputation extended to medial cuneiofrom. Open wedge osteotomy performed on medial cuneiform and first ray realigned, reduced to angel and linsfranc level metatarsal widening reduced. Moreover, soft tissue procedure was performed (transfer of the adductor and flexor attached tendon to the distal of the 1^st metatarsus and with lateral capsuloraphy. (Plantar facia and protected foot incised only dorsally and plantar ragion as an intact. Foot incised only dorsally was fixed with one cortical screw and short leg was fixed in plaster for six weeks. At week six, plaster was removed.

Conclusion: Treatment of congenital deformities like polydactyly at an early age may not always provide positive outcomes. A better clinical-radiological assessment should be made for such deformities. Moreover, They should be treated with a very good preoperative planning before reconstruction. It may be useful to wait for the adolescence period or completion of bone development in these cases like the one in our study.

In this study we describe a method of to make right decision to choose right finger amputation in order foot biomechanics, anatomical relationship of joints. The choice of amputation order in pre- axial polydactyly, as well as the advantages of ray amputation over pre-axial or post-axial ray amputation are discussed. The presence of tarsal coalition could be affecting this decision indicates the presence of a new deformity not found in the existing classifications, and a new classification item has been proposed.

Keywords: Polydactyly; Ray Amputation Foot; Tarsal Coalition

References

1. Bader B., et al. “Polydactyly of the foot”. Orthopedics 2 (1999): 125-132.
2. Vispo Seara. “Hallux varus congenitus”. Zeitschrift fur Orthopadie und ihre Grenzgebiete6 (1998): 542-547.
3. Falliner A., et al. “Hallux varus congenitus in polydactyly patients”. Zeitschrift fur Orthopadie und ihre Grenzgebiete 3 (1988): 239-249.
4. Bacardi-BE and Frankel-JP. “Biplane cuneiform osteotomy for juvenile metatarsus primus varus”. The Journal of Foot and Ankle Surgery 6 (1986): 472-478.
5. Shahcheraghi GH and Javid M MD. “Treatment of the Mirror Foot with Central Ray Resection: Report of 2 Cases”. Iranian Journal of Medical Sciences 5 (2018): 550-553.
6. Boutros S., et al. “An unusual case of polydactyly of the thumb”. Annals of Plastic Surgery 4 (1998): 434-435.
7. Hyo HS., et al. “New Classification of Polydactyly of the Foot on the Basis of Syndactylism, Axis Deviation, and Metatarsal Extent of Extra Digit”. Archives of Plastic Surgery 3 (2013).
8. Aucourt J., et al. “Congenital malformations of the hand and forearm in children: what radiologistsshould know”. Seminars in Musculoskeletal Radiology 2 (2012): 146-158.
9. Phelps DA and Grogan DP. “Polydactyly of the Foot”. Journal of Pediatric Orthopaedics 4 (1985): 446-451.
10. Blauth W. “Uber die Behandlung angeborener Fussfehlbildungen [The treatment of congenital foot abnormalities]”. Zeitschrift fur Orthopadie und ihre Grenzgebiete1 (1989): 3-14.
11. D'Souza D., et al. “A polydactylous human foot with 'double-dorsal' toes”. Journal of Anatomy 193 Pt 1.1 (1998): 121-130.
12. Gianfortune P., et al. “Ray resections in the insensitive or dysvascular foot: a critical review”. The Journal of Foot and Ankle Surgery 2 (1985): 103-107.
13. Bulut M., et al. “Ray amputation for the treatment of macrodactyly in the foot: report of three cases”. Acta Orthopaedica et Traumatologica Turcica 6 (2011): 458-462.
14. Chiang H and Huang SC. “Polydactly of the foot manifestations and treatment”. J Forms Med Assoc 96.3 (1997): 194-198.
15. Masada K., et al. “Treatment of preaxial polydactyly of the foot”. Plastic and Reconstructive Surgery 2 (1987): 251-258.
16. Meltzer RM. “Polydactyly”. Clinics in Podiatric Medicine and Surgery 1 (1987): 57-62.
17. Fontalis A., et al. “Midfoot Charcot Neuro-arthropathy Precipitated by First or Fifth ray Amputation”. Foot and Ankle Surgery 6 (2021): 673-676.
18. Kim J., et al. “Ray amputation for the treatment of foot macrodactyly in children”. The Bone and Joint Journal 97-B.10 (2015): 1364-1369.
19. Suh YC., et al. “Is Reconstruction Preserving the First Ray or First Two Rays Better Than Full Transmetatarsal Amputation in Diabetic Foot?” Plastic and Reconstructive Surgery 1 (2019): 294-305.
20. Shahcheraghi GH MD and Javid M MD. “Treatment of the Mirror Foot with Central Ray Resection: Report of 2 Cases”. Iranian Journal of Medical Sciences 5 (2018): 550-553.
21. Häller TV., et al. “Outcome of Ray Resection as Definitive Treatment in Forefoot Infection or Ischemia: A Cohort Study”. The Journal of Foot and Ankle Surgery 1 (2020): 27-30.
22. Riandini T., et al. “National Rates of Lower Extremity Amputation inPeople With and Without Diabetes in a Multi-Ethnic Asian Population: A Ten Year Study in Singapore”. European Journal of Vascular and Endovascular Surgery 1 (2022): 147-155.
23. Roukis TS. “Minimum-incision metatarsal ray resection: an observational caseseries”. The Journal of Foot and Ankle Surgery 1 (2010): 52-54.
24. Assal M., et al. “Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy. Surgical technique”. The Journal of Bone and Joint Surgery 1 Pt 1 (2010): 20-31.
25. Bevilacqua NJ., et al. “The narrowed forefoot at 1 year: an advanced approach for wound closure after central ray amputations”. Clinics in Podiatric Medicine and Surgery 1 (2008): 127-133.
26. Cohen MS. “Thumb Duplication”. Hand Clinics 1 (1998): 17-27.
27. Akn S. “An unusual and nonclassified central polydactyly of the foot”. Annals of Plastic Surgery 1 (2004): 86-88.
28. Boffeli TJ., et al. “Incidence and Clinical Significance of Heterotopic Ossification After Partial Ray Resection”. The Journal of Foot and Ankle Surgery 4 (2016): 714-719.
29. Wang HJ., et al. “Central-type eight-toed polydactyly associated with ipsilateral complex renogluteal agenesis: a case report with 8 years' follow-up”. Journal of Pediatric Surgery 3 (1996): 444-446.
30. Poylsen Kajaer L and Arlien SP. “Locked-in syndrome following cervical manipulation”. Acta Neurologica Scandinavica 6 (1987): 486-488.
31. Sobel E., et al. “Longitudinal epiphyseal bracket: associated foot deformities with implications for treatment”. Journal of the American Podiatric Medical surgery 1 (1987): 57-62.
32. Lui TH. “Correction of postaxial metatarsal polydactyly of the foot by percutaneous ray amputation and osteotomy”. The Journal of Foot and Ankle Surgery 1 (2013): 128-131.

Citation

Citation: Tolgay Satana and Fulya Doktorlar. “Treatment of Bilateral Preaxial Polydactyly with Second Digit Ray Amputation and Medial Cuneiform Open Wedge Osteotomy". Acta Scientific Orthopaedics 5.8 (2022): 101-105.

Copyright

Copyright: © 2022 Tolgay Satana and Fulya Doktorlar. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.