Methods for the Syndactyly Treatment of the Foot – Techniques, Indication, Timing and Outcome – Literature Review

Abstract

A common congenital disorder, is the development of syndactyly, affecting toes more than fingers. Often it follows an autosomal dominant pattern but can also be seen in genetic syndromes like Carpenter, Down, or Apert syndrome. Usually, Toe syndactyly causes more cosmetic concerns than having any functional difficulties. However, a syndrome associated toe syndactyly might cause walking and balancing difficulties, requiring surgical intervention. The optimal timing for treatment is not well researched upon, but 2 studies suggest that the optimal timing is when the patient is between 18-24 months of age. To reduce the risk of recurrence and minimize the risk of developing scars.

There are various techniques that have been developed for treating toe syndactyly. Such as the skin graft technique, for example M-to-V flap, where the skin graft donor site is for example the foot sole. Another technique, is the dorsal foot skin flap technique, such as the pentagonal or plane-shaped technique. These are favored due to their similar pigmentation and prevent the complications that might develop with using the skin graft technique. Tissue expansion technique is also used, which is done by using K-wires to expand the skin tissue in the webspace. Alternatively, Medical tattooing can also be done, which is a non-surgical treatment alternative when the patient has a simple incomplete toe syndactyly and wants to treat it.

Undergoing such procedures might cause the development of complications, such as keloid formation flap necrosis, or wound dehiscence. Thoroughly assessing and discussing the risks with the patient or the parents is crucial before undergoing such surgeries.