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Toe Syndactyly

Foot surgery is not my main area of expertise but because of the common association of congenital anomalies of the toes in children presenting with congenital differences of their fingers and hands, I frequently operate on the feet of young children.

Releasing webbing (syndactyly) in the hands is uncontroversial and is very much directed in improving both appearance and function. Releasing webbing in the feet is somewhat more controversial though, and because it is regarded as a strictly aesthetic procedure and because this, in turn, almost always necessitates the use of skin grafting, it is not routinely offer to young children. The reality is that most young children who have syndactylysed toes live with them untreated without major difficulty.

Webbing varies in severity, affecting some toes rather more than others i.e. more or less to towards the tip of the affected digits. In the most severe cases, the webbing will not only reach the tip of the toes, so that there is no gap, but the nail will be joined together, giving a rather unusual appearance to the foot. In these cases, the underlying bone is often joined together as well, at the end of the toes.

Surgery to release syndactylysed digits is an absolutely routine part of my practice in the upper limb but can work extremely well in the toes too. This involves rearranging the skin that is available to resurface the separated digits as far as possible. There is always an insufficiency of skin though and this, in turn, necessitates the use of skin grafting. Skin would typically be harvested from the groin crease, leaving a well-concealed scar. Skin grafts usually take well but always have an uncertain future, both in terms of whether they survive and also in terms of their cosmetic appearance.

In the most successful cases, de-syndactylysation of the toes will leave remarkably good clinical appearances. As far as recovery is concerned, it is important to keep the foot elevated for the first 10-14 days, as much as possible, to optimise the prospects for skin grafts to stick and for the wounds to heal quickly. Thereafter, dressing management is tailored according to the healing that is encountered in each case. Most patients will have to refrain from sports for at least 6 weeks and driving for 4-6 weeks.