Polydactyly

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What is polydactyly?

Polydactyly is a malformation of the hands and feet characterized by the presence of extra fingers or toes.  These extra fingers or toes can be located on either the medial or lateral side of the hand or foot and can range from fully formed, functional digits to small rudimentary bumps.

What causes polydactyly?

Polydactyly is primarily a congenital condition, meaning it is present at birth. The exact cause of polydactyly is often unknown, but it can be influenced by genetic and environmental factors. In some cases, it may be inherited, meaning it runs in families. Genetic counseling and evaluation can help determine the underlying cause and assess the risk of recurrence in future pregnancies.

What are the different types of polydactyly?

Polydactyly can manifest in various forms, each with its unique characteristics. The main types of polydactyly include:

1. Preaxial Polydactyly: This type involves the presence of an extra digit on the thumb side of the hand or the big toe side of the foot.
2. Postaxial Polydactyly: Postaxial polydactyly refers to the presence of an additional digit on the little finger side of the hand or the little toe side of the foot.
3. Central Polydactyly: Central polydactyly involves the presence of an extra digit located between the normal digits.

How is polydactyly diagnosed?

Polydactyly is typically diagnosed shortly after birth during a physical examination by a healthcare professional. The number, location, and structure of the extra digits are evaluated to determine the specific type of polydactyly.  As the child gets older, additional imaging studies such as X-rays or genetic testing may be recommended to assess the underlying bone structure and identify any associated conditions.

What are the treatment options for polydactyly?

The treatment approach for polydactyly depends on several factors, including the type of polydactyly, the number and function of the extra digits, and parental preferences. Treatment options may include:

• Surgical Intervention: Surgery is  the typical treatment for polydactyly for both functional  and cosmetic reasons. The surgical procedure aims to remove the extra digit, reconstruct the affected area, and ensure optimal hand or foot function. The specific surgical technique will depend on the type of polydactyly and the individual needs of the child. The goal is to create a hand or foot with a natural appearance and optimal functionality.
• Observation and Non-surgical Management: In some cases because of characteristics of the extra digit, familial wishes, or other health issues observation may be recommended. Regular follow-up visits will be scheduled to monitor the growth and development of the hand or foot.

When is surgery typically performed?

For simple cases of polydactyly surgery can sometimes be done under local numbing medicine in the  first few weeks of life without the need for general anesthesia.     For more involved cases, surgery to remove extra digits is typically performed between 1 and 2 years of age.  This allows for the child to grow in order to minimize risks associated with surgery and anesthesia while still allowing for removal of the extra digit before it can begin to impede hand or foot development or cause the child social issues.

What can I expect after treatment?

The post-treatment period will vary depending on the complexity of the polydactyly and the chosen surgical approach. Your child may experience some discomfort, swelling, or stiffness following surgery though these are often short lived.  Some children may require a cast after surgery in order to protect the surgical site. The healthcare team will provide guidance on pain management, wound care, and any necessary physical therapy.   Your child will then be regularly  seen in the postoperative time period in order to follow the healing process and watch for any potential issues.

Are there any potential complications associated with polydactyly?

While surgical treatment for polydactyly is generally safe, like any surgical procedure, there are potential risks and complications. These can include infection, bleeding, scarring, impaired wound healing, nerve damage, or unsatisfactory cosmetic outcomes. It's essential to discuss the potential risks with your child's healthcare team before proceeding with surgery.   Dr. Daggett will provide detailed information, answer your questions, and take necessary precautions to minimize the risks associated with the procedure.