Toe syndactyly revisited

Toe syndactyly affects around 1/2000 people and is associated with significant psychological morbidity. There are multiple techniques of toe syndactyly repair described in the literature which is indicative that as yet, no one method has proved superior to others. Here we describe the technique we employ and present results of surgery including a review of patient satisfaction.

We use a modification of the technique originally described by Mondolfi using interdigitating triangular skin flaps to recreate the web space and a split thickness skin graft harvested from the instep to address the skin shortage. Patient satisfaction data were collected using a multiple response 10 point modified Likert scale questionnaire.

15 patients and 19 conjoined toes were operated on by a single surgeon with an average follow up time of 16.3 months (range 3-30 months). Overall satisfaction with the procedure was high with a significant increase in satisfaction from 1.3/10 preoperatively to 9.3/10 post operatively. Furthermore, patients were found to have a significant reduction in concern about their condition from a preoperative score of 8.67 to score of 0.67 following surgery (p < 0.05). Of the 19 toes divided, we had 1 skin graft failure, 1 case of mild web creep and all donor sites healed well.

This is a simple technique that avoids unsightly dorsal scars and the glabrous skin graft provides excellent colour match with minimal morbidity. Complication rates seen with this technique are comparable or superior to those seen with other techniques already described in the literature. Toe syndactyly can be a relatively under treated condition and we have shown that offering these patients surgery can result in a highly satisfied patient group.