From the Guidelines
Surgical correction is the most effective approach for managing syndactyly and clinodactyly of toes, particularly when there are significant cosmetic concerns or functional impairments, as it can improve foot contour, reduce pain, and allow for normal footwear wear 1. When considering the management of syndactyly and clinodactyly of toes, it is essential to weigh the potential benefits against the risks of surgical intervention. The evidence suggests that surgical release of pseudosyndactyly can make it easier to wear normal footwear and has psychological benefits for the patient 1. Some key points to consider in the management of syndactyly and clinodactyly of toes include:
- Surgical procedures, such as mitten release, can reduce pain or difficulty in standing and walking, and improve the ability to wear shoes due to hyperextension contractures of the toes 1.
- Early extension procedures to address contractures of the toes and equinus and cavus deformities using soft-tissue surgery may be recommended by experts 1.
- However, contractures almost always recur, and patients may refuse further surgical interventions due to the lack of long-term benefit 1.
- Losartan administration has shown promise in preventing digit fusion in RDEB mouse models, and a clinical trial is currently ongoing to establish its safety, tolerance, and efficacy in children with RDEB 1. It is crucial to note that the decision to undergo surgical correction should be made on a case-by-case basis, taking into account the individual's specific condition, functional limitations, and cosmetic concerns. The goal of treatment should be to improve the patient's quality of life, reduce pain and discomfort, and enhance their ability to participate in daily activities 1.
From the Research
Management of Syndactyly
- The management of syndactyly of the toes involves surgical correction, with the type and severity of the condition determining the approach 2, 3.
- Physical therapy plays a crucial role in the postoperative treatment of syndactyly, with a physiotherapeutic program adapted to the patient's age and needs 4.
- The ultimate outcome of syndactyly treatment depends on the degree of deformity, with some cases requiring more complex procedures than others 2, 3.
Clinodactyly of Toes
- Clinodactyly is a congenital hand difference that can also affect the toes, although less common 5.
- The management of clinodactyly involves therapy or surgical correction, with the goal of improving both functional and social outcomes 5.
- Recent investigations have provided additional data on the expected outcomes following intervention for clinodactyly and other congenital hand differences 5.
Classification and Genetics
- Syndactyly is one of the most common hereditary limb malformations, with great inter- and intra-familial clinical variability 6.
- At least nine non-syndromic syndactylies with additional sub-types have been characterized, with most inherited as autosomal dominant 6.
- The underlying genes/mutations for some syndactyly types have been identified, but the etiology and molecular basis of others remain unknown 6.