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Wang Y, Hu Y, Lian X, Chen H. Toenail Composite Tissue Flap as a Novel Reconstructive Approach in the Treatment of Macrodactyly of the Foot. Plast Reconstr Surg 2024; 154:890-896. [PMID: 37832040 DOI: 10.1097/prs.0000000000011129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
BACKGROUND The microsurgical technique has been used to dissect macrodactyly into a composite tissue flap with arteries, veins, and toenail phalanxes to reconstruct the deformed toe into a nearly normal one. METHODS This study retrospectively collected relevant data from 10 patients undergoing toenail composite tissue flaps to reconstruct their macrodactyly. This case series included 2 female and 8 male pediatric patients with a mean age of 27.2 months (range, 8 to 64 months), who had been followed up for an average of 24.3 months after the reconstruction surgery (range, 3 to 57 months). The American Orthopedic Foot and Ankle Society Scale score was obtained by the operating surgeons before and after the reconstruction operation, and all the patients completed the postoperative questionnaires. RESULTS The reconstruction surgery took an average of 3 hours with minimal intraoperative blood loss. The postoperative American Orthopedic Foot and Ankle Society Scale score was significantly improved from the one before surgery (33.3 ± 12.4 versus 76.3 ± 10; P ≤ 0.001). The average score obtained from the postoperative questionnaires for foot macrodactyly was 9.4, in the range between 0 and 10 for the functional and aesthetic restorations. All reconstructed toes were viable without signs of infection or necrosis and possessed satisfactory function and appearance during the follow-up period after the reconstruction operations. CONCLUSION It is feasible and effective to dissect a macrodactyly into a composite tissue flap for being reconstructed into a nearly normal toe.
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Affiliation(s)
- Yang Wang
- From the Department of Hand and Foot Surgery, The Second Hospital of Shandong University
| | - Yong Hu
- From the Department of Hand and Foot Surgery, The Second Hospital of Shandong University
| | - Xiaojie Lian
- From the Department of Hand and Foot Surgery, The Second Hospital of Shandong University
| | - Hua Chen
- From the Department of Hand and Foot Surgery, The Second Hospital of Shandong University
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Thangavel A, Alsuwailim A, Albadran A, Almousa M, Al Molhim S, Alnafeesy SK, Almulhim A. Innovative Reconstructive Management of Foot Macrodactyly in a Pediatric Patient: A Case Report. Cureus 2023; 15:e51398. [PMID: 38192919 PMCID: PMC10773169 DOI: 10.7759/cureus.51398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/10/2024] Open
Abstract
Macrodactyly is a rare congenital anomaly characterized by disproportionate hypertrophy of one or more digits or the forefoot, involving some or all tissue types. It is nonhereditary and can present alone or alongside other deformities. Usually, macrodactyly is treated with amputation of the affected toe or finger to reduce the chance of recurrence. In this paper, we present the case of a child with macrodactyly who was treated successfully without amputation and instead with a reconstruction of the toe shape to resemble a near-natural-looking toe with intact functions. The patient was a one-year-old female who presented with macrodactyly of her right great toe, right second toe, and forefoot. She had no history of other congenital deformities or systemic diseases. A reconstruction surgery was performed, which involved debulking the right great toe, right second toe, and forefoot. Also, it included the creation of the first web space and the restoration of the nailbed of the second toe. Postoperative follow-up revealed minimal complications. Thus, a second reconstructive surgery was performed, which included debulking and further reconstruction of the foot to improve the result. Several techniques exist for the reduction of macrodactyly that can achieve optimal results. The choice of technique depends on the specifics of the case and the experience of the surgeon. We therefore hope our technique will be beneficial for the management of future cases of macrodactyly. One year of follow-up after the second operation revealed maintained function and no regrowth recurrence.
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Affiliation(s)
| | | | | | - Mazin Almousa
- Medicine and Surgery, King Faisal University, Al-Ahsa, SAU
| | | | - Saleh K Alnafeesy
- Medicine and Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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3
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Chen L, Huang W, Chen W, Tian X. Surgical treatment of macrodactyly of the foot in children. J Plast Surg Hand Surg 2023; 57:115-121. [PMID: 36849126 DOI: 10.1080/2000656x.2021.2017293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of the study was to produce an algorithm and surgical procedure for optimum treatment of pedal macrodactyly. Surgery was performed on 27 feet of 26 patients with a mean age of 33 months at the time of surgery (range: 7-108 months). A multi-technique procedure based on the involved elements of the foot (soft tissue, phalanx, or metatarsal, or a combination of these) was adopted. The intermetatarsal width ratio, phalanx spread angle, and metatarsal spread angle was used to evaluate the severity of the macrodactyly and the effect of treatment. The Oxford Ankle Foot Questionnaire for Children and the Questionnaire for Foot Macrodactyly were employed to evaluate the clinical results. Under the guidelines of the treatment algorithm, all patients were successfully operated on using the multi-technique procedure; the sizes of the affected feet decreased significantly. After a mean of 33 months (range: 18-42 months) follow-up, the intermetatarsal width ratio decreased from 1.13 to 0.93 (p < 0.05), the phalanx spread angle decreased from 31.3° to 17.9° (p < 0.05), the metatarsal spread angle decreased from 33.2° to 15.8° (p < 0.05), and the mean score for the Oxford Ankle Foot Questionnaire for Children improved from 42 to 47 (p < 0.05) after surgery. The mean score for the Questionnaire for Foot Macrodactyly was 9.35 at the time of follow-up. The goal of the treatment of pedal macrodactyly is to obtain a functional and cosmetically acceptable foot. This treatment algorithm and multi-technique procedure could fully satisfy this goal.
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Affiliation(s)
- Lu Chen
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education, Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Wei Huang
- Department of Joint Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Chen
- Ministry of Education, Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Department of Burn and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaofei Tian
- Ministry of Education, Key Laboratory of Child Development and Disorders, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Department of Burn and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
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4
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Abstract
This article explores different pediatric forefoot deformities including syndactyly, polydactyly, macrodactyly, curly toe, and congenital hallux varus. The epidemiology and genetic background are reviewed for each condition. Preferred treatment options and recommended surgical techniques are discussed with review of the current literature.
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Affiliation(s)
- Maryellen P Brucato
- Brucato Foot and Ankle Surgery, LLC, 1011 Clifton Avenue, Suite 1G, Clifton, NJ 07013, USA.
| | - David Y Lin
- The Pediatric Orthopedic Center, 218 Ridgedale Avenue, Suite 101, Cedar Knolls, NJ 07927, USA
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5
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Rougereau G, Fitoussi F, Marty-Diloy T, Bachy M, Vialle R, Langlais T. Strategy and clinical outcomes of child foot surgery for macrodactyly. Orthop Traumatol Surg Res 2021; 109:103109. [PMID: 34648998 DOI: 10.1016/j.otsr.2021.103109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Amputation of the abnormal segment seems to be the reference standard treatment for the surgical management of macrodactyly of the foot in children. Our objectives here were to detail the surgical strategies according to the cause, anatomical characteristics, and static or progressive nature of the macrodactyly and to evaluate the long-term clinical outcomes. HYPOTHESIS Conservative treatment can be an option in the management of static macrodactyly of the foot in children. MATERIAL AND METHODS We retrospectively included 24 feet in 19 patients seen consecutively. There were 12 primary and 12 secondary types. The macrodactyly was static in 9 cases and progressive in 15 cases. The treatment consisted in either conservative procedures or amputation of the segment. All patients completed the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) to evaluate their quality of life, shoe wear issues, and satisfaction with their treatment. RESULTS Mean age at first surgery was 5.8 years (range, 0.5-11.5) and the mean interval between two procedures was 2.3 years (range, 0.3-5.5). Mean number of procedures per foot was 2.2 par pied (range, 0-7). All 9 static forms were managed conservatively. Amputation was performed in 11 of the 15 progressive forms. The mean number of procedures was significantly higher in the progressive forms (4.1 vs. 1.5/pied; p=0.006). Two patients died during follow-up. The remaining 17 patients, with 22 affected feet (primary and secondary in 11 cases; progressive in 14 cases and static in 8 cases) were re-evaluated. Mean follow-up was 9.4 years (range, 2.7-20.6). The final OxAFQ-C score was 46/60 (range, 18-58). Of the 17 patients, 86% would be willing to repeat the same surgical procedures and 77% were satisfied with their treatment at last follow-up. We found no differences between the groups managed with amputation and with conservative treatment regarding quality of life, satisfaction, or shoe size difference. CONCLUSIONS Conservative treatment deserves a place in the treatment of static macrodactyly of the foot in children. Regarding amputation of the segment in progressive forms, it is important to reassure the patients and parents about the expected results but also to inform them about the risk of requiring repeat surgical procedures. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Gregoire Rougereau
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France; Département de chirurgie orthopédique, hôpital Pitié-Salpêtrière, Sorbonne université, Paris, France
| | - Franck Fitoussi
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Thibault Marty-Diloy
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Manon Bachy
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France
| | - Raphaël Vialle
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France; Département universitaire MAMUTH des thérapies innovantes en matière de maladies musculo-squelettiques, Paris, France
| | - Tristan Langlais
- Département d'orthopédie pédiatrique, hôpital Armand-Trousseau, Sorbonne université, Paris, France; Hôpital des enfants, Purpan, Toulouse université, Toulouse, France.
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Bernhard SM, Adam L, Atef H, Häberli D, Bramer WM, Minder B, Döring Y, Laine JE, Muka T, Rössler J, Baumgartner I. A systematic review of the safety and efficacy of currently used treatment modalities in the treatment of patients with PIK3CA-related overgrowth spectrum. J Vasc Surg Venous Lymphat Disord 2021; 10:527-538.e2. [PMID: 34358672 DOI: 10.1016/j.jvsv.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/22/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND PIK3CA (activating mutations of the p110α subunit of phosphatidylinositol 3-kinases)-related overgrowth spectrums (PROS) include a variety of clinical presentations that are associated with hypertrophy of different parts of the body. We performed a systematic literature review to assess the current treatment options and their efficacy and safety for PROS. METHODS A literature search was performed in Embase, MEDLINE (Ovid), Web of Science Core Collection, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Google Scholar to retrieve studies on the treatment of hypertrophy in PROS. Randomized controlled trials, cohort studies, and case series with ≥10 patients were included in the present review. The titles, abstracts, and full text were assessed by two reviewers independently. The risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS We included 16 studies of the treatment of hypertrophy in PROS patients, 13 (81.3%) from clinical retrospective studies and 3 (13.7%) from prospective cohort studies. The risk of bias grade was low for 2, medium for 12, and high for 2 studies. Of the 16 studies, 13 reported on surgical treatment and 3 reported pharmacologic treatment using phosphatidylinositol-3-kinase (PI3K)/mammalian target of rapamycin (mTOR) pathway inhibitors in PROS patients. In 3 studies, PROS was defined by a mutation in the PIK3CA gene, and 13 studies relied on a clinical definition of PROS. Surgical therapy was beneficial for a specific subgroup of PROS (macrodactyly). However, little has been reported concerning surgery and the potential benefits for other PROS entities. The reported side effects after surgical therapy were mostly prolonged wound healing or scarring. PI3K/mTOR pathway inhibition was beneficial in patients with PROS by reducing hypertrophy and systemic symptoms. The adverse effects reported included infection, changes in blood count, liver enzymes, and metabolic measures. CONCLUSIONS Surgery is a locally limited treatment option for specific types of PROS. A promising treatment option for PROS is pharmacologic PIK3CA inhibition. However, the level of evidence on the treatment of overgrowth in PROS patients is limited.
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Affiliation(s)
- Sarah M Bernhard
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luise Adam
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Hady Atef
- Faculty of Physical therapy, Cairo University, Cairo, Egypt; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Dario Häberli
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wichor M Bramer
- Medical Library, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Beatrice Minder
- Public Health and Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Yvonne Döring
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany
| | - Jessica E Laine
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jochen Rössler
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Southard EJ, Sands AK, Boyajian DA, Sieczka E, Bryk E, Vigorita VJ. Macrodystrophia Lipomatosa of the Foot: A Case Report of MRI and Histologic Findings Including Pacinian Corpuscle Abnormalities. JBJS Case Connect 2021; 11:01709767-202106000-00122. [PMID: 34129539 DOI: 10.2106/jbjs.cc.20.00785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CASE A 37-year-old man presented with pain and macrodactyly of a toe. Imaging and histology demonstrated findings consistent with macrodystrophia lipomatosa (MDL). We compared our findings with control tissue obtained from an identical site of a fresh-frozen cadaveric foot from the same anatomical site. Pacinian corpuscles (PCs) in the MDL tissue were increased in number, size, and shape compared with the control tissue and demonstrated edematous interstitial lamellae and vacuolar degenerative change. We also document the magnetic resonance imaging findings of the PCs. CONCLUSION Peculiar abnormalities of PCs in MDL underline nerve damage and may be a contributing factor in the pain associated with this unusual condition.
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Affiliation(s)
- Edward J Southard
- Departments of Orthopaedic Surgery and Radiology, New York Presbyterian Lower Manhattan Hospital, New York, New York
- Kingsbrook Jewish Medical Center, Brooklyn, New York
| | - Andrew K Sands
- Departments of Orthopaedic Surgery and Radiology, New York Presbyterian Lower Manhattan Hospital, New York, New York
- Kingsbrook Jewish Medical Center, Brooklyn, New York
| | - David A Boyajian
- Departments of Orthopaedic Surgery and Radiology, New York Presbyterian Lower Manhattan Hospital, New York, New York
- Kingsbrook Jewish Medical Center, Brooklyn, New York
| | - Elizabeth Sieczka
- Departments of Orthopaedic Surgery and Radiology, New York Presbyterian Lower Manhattan Hospital, New York, New York
- Kingsbrook Jewish Medical Center, Brooklyn, New York
| | - Eli Bryk
- Departments of Orthopaedic Surgery and Radiology, New York Presbyterian Lower Manhattan Hospital, New York, New York
- Kingsbrook Jewish Medical Center, Brooklyn, New York
| | - Vincent J Vigorita
- Departments of Orthopaedic Surgery and Radiology, New York Presbyterian Lower Manhattan Hospital, New York, New York
- Kingsbrook Jewish Medical Center, Brooklyn, New York
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Phalangectomy combination double-pedicled digital artery flap for second-toe macrodactyly reconstruction: A case report. Int J Surg Case Rep 2021; 81:105767. [PMID: 33752034 PMCID: PMC7985412 DOI: 10.1016/j.ijscr.2021.105767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022] Open
Abstract
Pedal macrodactyly is a rare form of congenital deformity. The goal of most macrodactyly is to reconstruct the affected toes to the normal size. We report a macrodactyly with an enlargement of the right foot index and middle toes. The patient underwent phalangectomy double-pedicle medial and lateral digital artery flap. 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.
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Chen W, Tian X, Chen L, Huang W. Clinical characteristics of 93 cases of isolated macrodactyly of the foot in children. J Orthop Surg Res 2021; 16:121. [PMID: 33557883 PMCID: PMC7869226 DOI: 10.1186/s13018-020-02196-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to describe the clinical characteristics of macrodactyly of the foot through a large cohort of cases to further understand this rare entity. METHODS Medical records, clinical photographs, plain radiographs, pathological findings, and intraoperative photographs of 95 feet of 93 patients were reviewed. Data including age; sex; laterality; ethnicity; birthplace; family history; and history of gestation, environment, whether smoking, or drinking during pregnancy were collected and analyzed. RESULTS Female patients (60%), left foot (56%), and static overgrowth (63%) were more prominent in the study cohort. Southern provinces (74%) and Han Chinese ethnicity (95%) predominated in terms of geographical region and demographic distribution, respectively. Multiple-toe involvement was 2.01-times more frequent than single-toe involvement. All five toes were involved with midline toes being most frequently affected overall and a medial distribution being more common than a lateral one. The forefoot was affected in 90 feet. The affected areas (toes and forefeet) were mostly located in the innervation of the affected medial plantar nerve (91%). The nerves showed enlargement in 49 feet, fatty infiltration in 25, a tortuous course in one, and were normal in 10 feet. Only six feet involved the musculature. Enlargement of phalanges and metatarsals were observed in 92 and 57 feet, respectively, and advanced bone maturation was seen in 63 feet. Twenty-two cases had syndactyly. CONCLUSIONS Macrodactyly of the foot is a rare congenital malformation with diverse clinical manifestations and multiple elements' involvement. It also presents the characteristics of nerve-mediated overgrowth and "nerve territory-oriented" deformity similar to that of macrodactyly of the hand.
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Affiliation(s)
- Wei Chen
- Department of Joint Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaofei Tian
- Department of Burn and Plastic Surgery, Children's hospital of Chongqing Medical University, Chongqing, China
- Department of Ultrasound, Children's hospital of Chongqing Medical University, No. 136 Zhongshan Er Road, Yuzhong District, 400014, Chongqing, China
- China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lu Chen
- Department of Ultrasound, Children's hospital of Chongqing Medical University, No. 136 Zhongshan Er Road, Yuzhong District, 400014, Chongqing, China.
- China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China.
- National Clinical Research Center for Child Health and Disorders, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, China.
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
| | - Wei Huang
- Department of Joint Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Chen W, Tian X, Chen L, Huang W. Macrodactyly of the foot resulting from plantar nerve impairment. J Plast Reconstr Aesthet Surg 2020; 74:1840-1847. [PMID: 33384233 DOI: 10.1016/j.bjps.2020.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/18/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
The role of the plantar nerve in the pathogenesis of macrodactyly of the foot is unknown. We investigated the distribution of affected toes and forefoot in 27 feet of 26 patients with pedal macrodactyly, and how this relates to innervation of the affected plantar nerve. A preoperative ultrasound examination was performed to determine the diameter and structure of the plantar nerve. Histologic findings were recorded during surgery. The microstructure of affected plantar nerves was evaluated by hematoxylin-eosin staining, while S100 expression was assessed by immunofluorescence analysis. Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) gene mutation in the affected nerve tissue was detected by Sanger DNA sequencing. The affected toes and forefoot involved innervation of the medial plantar nerve in 25/27 feet, the lateral plantar nerve in one foot, and both medial and lateral plantar nerves in one foot. All affected plantar nerves, which were accompanied by a fatty strip, were surrounded by or infiltrated with fat. The affected plantar nerves showed enlargement, a tortuous course, fatty infiltration, or a combination of these. Pathologic changes in affected plantar nerves involved only the epineurium and not the perineurium or endoneurium. Expression of the Schwann cell marker S100 was absent in some areas of affected nerves. Sequencing of PIK3CA exons identified a gain-of-function mutation (p.His1047Arg) in affected plantar nerves. These results indicate that pathologic impairment of the plantar nerve can lead to macrodactyly of the foot, which may be considered as a nerve trunk disease.
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Affiliation(s)
- Wei Chen
- Department of Joint Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaofei Tian
- Department of Burn and Plastic Surgery, Children's hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Lu Chen
- Department of Ultrasound, Children's hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Wei Huang
- Department of Joint Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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11
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Kalb JP, Suarez DA, Herrera AM. Bilateral Macrodactyly of the Halluces in an Adolescent Girl Corrected with Shortening Osteotomies of the First Metatarsal and the Phalangeal Bones: A Case Report. JBJS Case Connect 2018; 8:e58. [PMID: 30045081 DOI: 10.2106/jbjs.cc.17.00314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Juan Pedro Kalb
- Foot and Ankle Orthopaedics (J.P.K.), Epidemiology Unit (A.M.H.), and Clínica del Campestre (J.P.K., D.A.S., and A.M.H.), Medellín, Colombia
| | - David Andrés Suarez
- Foot and Ankle Orthopaedics (J.P.K.), Epidemiology Unit (A.M.H.), and Clínica del Campestre (J.P.K., D.A.S., and A.M.H.), Medellín, Colombia
| | - Ana Milena Herrera
- Foot and Ankle Orthopaedics (J.P.K.), Epidemiology Unit (A.M.H.), and Clínica del Campestre (J.P.K., D.A.S., and A.M.H.), Medellín, Colombia
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Park YH, Jeong SM, Choi GW, Kim HJ. The role of the width of the forefoot in the development of Morton's neuroma. Bone Joint J 2017; 99-B:365-368. [PMID: 28249977 DOI: 10.1302/0301-620x.99b3.bjj-2016-0661.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 11/14/2016] [Indexed: 11/05/2022]
Abstract
AIMS Morton's neuroma is common condition of the forefoot, but its aetiology remains unclear. Our aim was to evaluate the relationship between the width of the forefoot and the development of a Morton's neuroma. PATIENTS AND METHODS Between January 2013 and May 2016, a total of 84 consecutive patients (17 men, 67 women) with a unilateral Morton's neuroma were enrolled into the study. The involved and uninvolved feet of each patient were compared. A control group of patients with symptoms from the foot, but without a neuroma who were matched for age, gender, affected side, and web space location, were enrolled. The first to fifth intermetatarsal distance, intermetatarsal angle and intermetatarsal distance of involved web space on standing radiographs were assessed. RESULTS The inter- and intra-observer reliability was excellent. The three parameters did not differ significantly between the involved and uninvolved feet. Neither did they differ significantly between the patients and the controls. CONCLUSION We conclude that there is no significant relationship between the width of the forefoot and the development of a Morton's neuroma. Cite this article: Bone Joint J 2017;99-B:365-8.
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Affiliation(s)
- Y H Park
- Korea University Guro Hospital, Department of Orthopaedic Surgery, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - S M Jeong
- Korea University Guro Hospital, Department of Orthopaedic Surgery, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - G W Choi
- Korea University Ansan Hospital, Department of Orthopaedic Surgery, 123 Jeokgeum-ro, Danwon-gu, Ansan, 15355, Korea
| | - H J Kim
- Korea University Guro Hospital, Department of Orthopaedic Surgery, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Korea
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