Lower extremity postaxial polydactyly: Current literature status and future avenues

Area of Science:

• Orthopedics
• Pediatric Surgery
• Congenital Anomalies

Background:

• Lower extremity polydactyly (LEP) is the most frequent congenital foot anomaly.
• LEP has significant functional and psychosocial implications.
• Comprehensive reviews on LEP management are lacking.

Purpose of the Study:

• To conduct a systematic review of clinical studies on LEP.
• To establish an evidence-based approach for clinical management.
• To analyze functional and esthetic outcomes of postaxial polydactyly treatment.

Main Methods:

• Scoping systematic review of primary clinical studies.
• Data collection on patient characteristics, diagnostics, and surgical techniques.
• Qualitative synthesis of outcomes including pain, infection, cosmesis, and mobility.

Main Results:

• 375 cases of LEP from 9 studies reviewed; mean follow-up 42.7 months.
• Ray dominance and syndactyly are key surgical planning factors; age at surgery is not.
• Common complications include calluses (22.1%), infections (2.5%), and pain (11.9%).
• Significant residual valgus (10.6%) and esthetic deformities (41.2%) were noted.

Conclusions:

• Excision of the non-dominant ray is the standard LEP management.
• Excellent long-term functional outcomes are achievable with current techniques.
• Minimizing esthetic issues and managing residual valgus remain challenges.
• A therapeutic algorithm for optimal LEP management is proposed.