Polydactyly and polysyndactyly of the fifth toe

Classification and treatment of polydactyly and polysyndactyly of the fifth toe are described based on a study of 37 patients with 46 affected feet. Polydactyly was seen in 26.1% of duplicated toes, polysyndactyly in 28.3%, and polysyndactyly fused with the fourth toe in 45.7%. Thirty-three patients with 42 toes were surgically treated. The medial toe was removed in patients with the duplicated fifth toe fused with the neighboring fourth toe; if necessary, a free full-thickness skin graft was performed on the fourth toe and not on the fifth toe. Either the lateral or the medial fifth toe was excised for better contour of the forefoot in patients with polysyndactyly without fusion with the fourth toe. The lateral digital ray, including the metatarsal, was excised in patients with polydactyly of the metatarsal type. The average age of patients at operation was 12.3 months (range, five days to five years). Reorganization of the foot was facilitated when the child was treated early or before it could walk.