Les macrodactylies de la main et du pied

Shortening Scarf Osteotomy for Macrodactyly and Valgus of the Hallux in Acrodysostosis Lesser Toes Brachydactyly

Level V: Case report.

Phalangectomy combination double-pedicled digital artery flap for second-toe macrodactyly reconstruction: A case report

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Pedal macrodactyly is a rare form of congenital deformity.

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The goal of most macrodactyly is to reconstruct the affected toes to the normal size.

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We report a macrodactyly with an enlargement of the right foot index and middle toes.

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The patient underwent phalangectomy double-pedicle medial and lateral digital artery flap.

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Satisfactory results were noted at evaluation after surgery.

Introduction

Pedal macrodactyly is a rare form of congenital deformity in which the toes and underlying structures are enlarged. The goal of most macrodactyly reconstruction surgeries is to reconstruct the affected toes to resemble the normal size such that the patient is able to wear shoes of the same size.

Case presentation

We report a three-year-old female patient presenting with an enlargement of the right foot index and middle toes. The anomaly was noticed at two months of age and grew progressively. X-ray imaging revealed enlarged bones and soft-tissue hypertrophy proximal to the distal phalanx of the second and third digits. There was no history of other systemic or syndromic diseases. The patient underwent phalangectomy surgery involving reduction of the fibrofatty tissue, double-pedicle medial and lateral digital artery flap. Satisfactory results were noted at evaluation two months of after surgery.

Conclusion

Macrodactyly reduction surgeries are generally composed of several kinds of surgical techniques to provide the best results. The management of macrodactyly depends on the surgeon’s experience while considering the most suitable surgical technique to be performed in each case. Therefore, it was deemed necessary to report this case and its surgical technique. We hope that this case report will enrich the existing literature and be useful for the management of macrodactyly cases.

[Real macrodactylia affecting the nerves]

La vraie macrodactylie représente une anomalie congénitale rare d'étiologie inconnue, caractérisée par une augmentation de taille de tous les éléments d'un ou plusieurs rayons de la main. Elle est habituellement isolée et comporte une infiltration fibrograisseuse prédominant en palmaire. Elle peut être expliquée par des anomalies d'ordre embryologique ou neurogène; avec ou sans orientation nerveuse selon que le territoire concerné par la macrodactylie comporte une augmentation du volume d'un nerf majeur, le plus souvent le médian. Du point de vue évolutif, il faut distinguer la forme statique (présente à la naissance et restant stable avec la croissance) de la forme progressive (ou la croissance est disproportionnée). Certains syndromes, tumeurs ou malformations peuvent comporter une augmentation de volume d'un doigt sans qu'on puisse parler de vraie macrodactylie. Cette malformation engendre un handicap fonctionnel mais également un préjudice esthétique. Le traitement comporte non seulement la chirurgie mais aussi une prise en charge rééducative.

Bilateral Macrodactyly of the Halluces in an Adolescent Girl Corrected with Shortening Osteotomies of the First Metatarsal and the Phalangeal Bones: A Case Report

CASE

A 14-year-old girl presented with painful high-arched feet and unusual, asymptomatic, bilateral macrodactyly of the halluces. After a year of observation, a surgical reduction was performed because of the psychological effect that the abnormality had on the patient. Bilateral shortening osteotomies of the metatarsal and the proximal phalangeal bones were performed. At 2 months after surgery, complete bone healing and alignment had been achieved. At the 5-year follow-up, we noted fully functional big toes, plantigrade feet, bilateral proper toe formula, and extreme patient satisfaction with the cosmetic results.

CONCLUSION

Dual osteotomies for toe shortening in a patient with bilateral nondysmorphic macrodactyly provided appropriate length reduction and satisfactory aesthetic and functional results.

Ray reduction of the foot in the treatment of macrodactyly and review of the literature

Macrodactyly of the foot is a rare disorder characterized by enlargement of the soft tissue and osseous elements of the foot that impedes the development of normal function and gait. Despite the morbidity associated with this condition, many surgeons are reluctant to perform surgical reduction. In the present report, we describe 3 pediatric patients with pedal macrodactyly, who underwent surgical correction consisting of amputation of the most enlarged ray, reduction of the adjacent rays, and ray transposition, combined with debulking of soft tissues. All 3 patients subsequently developed a normal gait and were able to wear normal, or minimally adjusted, shoes. We advocate early surgical treatment of macrodactyly of the foot to enhance the development of normal function and gait.