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Surgical Strategies for Cleft Foot Deformity in a Pediatric Population
David E Westberry1, Caroline E Bailey2, Sonia Garg2
1Shriners Hospitals for Children-Greenville.
Background:
Ectrodactyly (cleft foot) is a rare congenital deformity characterized by central ray deficiency. Surgical intervention is considered for pain, shoe-wear difficulty, callosities, or cosmetic concerns. This multicenter study evaluates indications, surgical strategies, radiographic correction, and incorporates intra- and inter-rater reliability testing of the Blauth and Abraham classification systems.
Methods:
A retrospective multicenter review was conducted of patients with ectrodactyly treated operatively between 2010 and 2022. Demographic, clinical, and radiographic data were collected, including preoperative shoe-wear difficulty, pain, and cosmesis concerns. Surgical indications, operative strategies, complications, revisions, and long-term outcomes were analyzed. Radiographic outcomes included forefoot splay angle and splay index.
Results:
Sixty-six patients (101 feet) underwent surgical intervention for ectrodactyly of the foot at a mean age of 5.8±4.5 years, with a mean follow-up of 3.7±3.5 years. Shoe-wear difficulty was the most common indication for surgery (79 feet, 82%), followed by pain (51 feet, 53%), calluses or skin complaints (25 feet, 26%), and/or cosmetic concerns (10 feet, 10%). Approximately 68% of procedures were performed for Blauth type II to IV deformities. Initial surgeries included 16 soft-tissue-only, 23 bony procedures, and 59 combined approaches. Common techniques included forefoot narrowing osteotomies (32%), soft-tissue cleft closure (30%), and ray excision (11%). Eight feet (8%) underwent revision due to recurrent deformity. Radiographs demonstrated significant improvements in forefoot splay angle (36.14 to 21.39 degrees, P <0.001) and splay index (1.88 to 1.69, P <0.001).
Conclusion:
Operative management of foot ectrodactyly provides favorable radiographic outcomes. Combined bony and soft-tissue strategies were most common, yielding significant radiographic correction with low revision rates. As the largest multicenter series on cleft foot reconstruction, this study highlights considerable management heterogeneity across centers and underscores the need for an indication-based classification system that integrates radiographic severity with patient-centered concerns to guide surgical decision-making and standardize care.
Level Of Evidence:
Level III.
