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Central Polydactyly of Toes

Mirror Foot


Presentation

  • This book presents the most common site-specific pediatric orthopedic problems seen in clinical practice.[books.google.com]
  • To conclude, a case of nine toes mirror foot is presented. At first operation a supernumerary tarsal bone was not excised. After a 7.5 year gap in followup the patient was presented with varus deformity of the first ray.[ijoonline.com]
  • Malformations presented by the patient cannot be included in any of the current classifications for polydactyly, because they are complex and widespread, leaving no place to site exceptional cases such as the one presented.[faoj.org]
  • When presenting as an isolated condition, polydactyly can be a correctable issue with a good outcome. Summary Preaxial polydactyly: Thumb or great toe side extra digit.[adoption.umn.edu]
  • Myopia is sometimes present. The ERG reveals generalized rod and cone dysfunction in some eyes, but may be normal in others. In many eyes the ERG is nonrecordable. Cataracts are frequently present.[disorders.eyes.arizona.edu]
Pallister-Hall Syndrome
  • Living with What is polydactyly, and what types of polydactyly can be seen in Pallister-Hall syndrome? When someone has polydactyly, they have extra fingers and/or toes.[thinkgenetic.com]
  • […] post-axial 5 megalencephaly, polymicrogyria, polydactyly, and hydrocephalus (MPPH) syndrome 2 oral-facial-digital syndromes oral-facial-digital syndrome (OFDS) type II - Mohr syndrome : post-axial oral-facial-digital syndrome (OFDS) type VI : post-axial 4 Pallister-Hall[radiopaedia.org]
  • […] unilateral renal agenesis, hypertelorism, congenital deafness, Meckel Gruber syndrome, Joubert-Boltshauser syndrome, Laurin-Sandrow syndrome, McKusick-Kaufman syndrome, mirror hand deformity (ulnar dimelia), Mohr syndrome, oral-facial-digital syndrome, Pallister-Hall[clinicaladvisor.com]
  • Associated syndromes include Bardet-Biedl syndrome, chondroectodermal dysplasia (Ellis-van Creveld syndrome), Greig cephalopolysyndactyly syndrome, McKusick-Kaufman syndrome, Pallister-Hall syndrome, trisomy 13, trisomy 21, and Weyers acrofacial dysostosis[consultant360.com]
Dysostosis
  • Associated syndromes include Bardet-Biedl syndrome, chondroectodermal dysplasia (Ellis-van Creveld syndrome), Greig cephalopolysyndactyly syndrome, McKusick-Kaufman syndrome, Pallister-Hall syndrome, trisomy 13, trisomy 21, and Weyers acrofacial dysostosis[consultant360.com]
Difficulty Walking
  • She had difficulties walking and shoe wearing. A cutaneous scar was noted over the medial aspect of the right foot as a result of the previous surgical intervention. The right foot was wide; with abduction of the first MTP joint [Figure 2] a.[ijoonline.com]
Whipple Disease
  • Ménétrey P070 Isolated knee arthritis as early and only symptom of Whipple’s disease: a case report Poster A05 D. Giunchi Vortragender E. Testa L. Deabate M. Delcogliano C. Candrian P.[organizers-congress.org]
Foot Deformity
  • Refine your mastery with state-of-the-art coverage of the very latest topics in foot and ankle surgery, including ankle reconstruction and total ankle arthroplasty; external/internal fixation; management of the complex foot deformities; nerve disorders[books.google.com]
  • Nine toes; Mirror Foot Deformity.[ijoonline.com]
  • SEP 2000; 51 (9) : 685-687 Carranza-Bencano-A; Gomez-Arroyo-JA; Fernandez-Torres-JJ; Moya-Corral-F Foot deformities associated with Apert syndrome [letter] J-Am-Podiatr-Med-Assoc. 2000 Jun; 90(6): 322-4 Foucher-G; Medina-J; Navarro-R; Pajardi-G Value[malattierare.regione.veneto.it]
  • Multiplanar supramalleolar osteotomy in the management of complex rigid foot deformities in children. J Child Orthop. 2009 Feb. 3 (1):39-46. [Medline]. [Full Text].[emedicine.medscape.com]
  • These are complex disorders involving cranial and maxillofacial abnormalities, upper extremity variations of polysyndactyly and foot deformities that include polysyndactyly and major rearfoot coalitions.[podiatrytoday.com]
Arthritis
  • 557 423 The limping child 568 431 Osteomyelitis 570 432 Septic suppurative arthritis 578 44 Juvenile rheumatoid arthritis 581 45 Tumors 585 452 Benign bone tumors and tumorlike lesions 595 453 Malignant bone tumors 611 454 Soft tissue tumors 622 455 Therapeutic[books.google.com]
  • Ménétrey P070 Isolated knee arthritis as early and only symptom of Whipple’s disease: a case report Poster A05 D. Giunchi Vortragender E. Testa L. Deabate M. Delcogliano C. Candrian P.[organizers-congress.org]
Long Leg
  • A long leg cast was applied for two weeks. After this period the sutures were removed and short leg cast was applied for following four weeks. After six weeks full weight bearing was allowed.[ijoonline.com]
Knee Pain
  • 3313 Knee contractures 361 3314 Differential diagnosis of knee pain 364 3315 Indications for imaging procedures for the knee 365 34 Foot and ankle 366 342 Radiographic techniques for the foot and ankle 372 343 Congenital clubfoot 374 345 Other congenital[books.google.com]

Workup

  • Since it is a condition that is generally uncommon in Caucasians, genetic workup should be considered in a Caucasian child with polydactyly. Preaxial Polydactyly : Preaxial polydactyly means that the extra digit(s) is on the thumb or big toe side.[adoption.umn.edu]
  • July 15, 2011), a database of human genes and genetic disorders, and syndromic polydactyly is commonly an autosomal recessively inherited trait. 4 Because hand and foot polydactyly are associated with congenital defects in 23.4% of patients, a genetic workup[clinicaladvisor.com]

Treatment

  • Achieve the best possible outcomes with authoritative answers on every major aspect of the treatment and management of foot and ankle disorders and diseases![books.google.com]
  • Treatment of this anomaly is complex because it has both functional and a esthetic implications. [6], [7] McCarthy et al. and Galois et al. stated that the surgical treatment of preaxial polydactyly is complex with poor long term result. [3], [4] Most[ijoonline.com]
  • Septic suppurative arthritis 578 44 Juvenile rheumatoid arthritis 581 45 Tumors 585 452 Benign bone tumors and tumorlike lesions 595 453 Malignant bone tumors 611 454 Soft tissue tumors 622 455 Therapeutic strategies for bone and soft tissue tumors 631 Treatment[books.google.com]
  • Operative treatments are discussed throughout the book with the key focus on managing the patient and the use of the conservative approach. As such, the main benefit of this book is as a diagnostic tool to assess children with orthopedic disease.[books.google.com]
  • Treatment General Measures Mild, type B postaxial polydactyly: Treatment in the newborn: Tie off the digit if it has no underlying skeletal connection.[orthopaedicclinic.com.sg]

Prognosis

  • […] the upper extremity 485 357 Fractures of the upper extremities 494 358 Tumors of the upper extremities 522 41 Traumatology basic principles 532 413 Diagnosis 533 414 Special injuries 536 415 Therapeutic principles 540 416 Followup management 543 418 Prognosis[books.google.com]
  • An autosomal dominant pattern of transmission is also associated with a favorable prognosis.[roentgenrayreader.blogspot.com]
  • […] non-syndromic macrodystrophia lipomatosa syndactyly : most common associated limb anomaly, it is then termed polysyndactyly If it is an isolated anomaly it is incidental and not of concern but if associated with another anomaly it then carries a vastly variable prognosis[radiopaedia.org]
  • Prognosis The prognosis for isolated polydactyly is excellent. When polydactyly is associated with another genetic syndrome, the prognosis is dependent on the presence of other features of that syndrome.[encyclopedia.com]
  • Surgery Excision of the least developed digit, with preservation of the UCL and osteotomy, if indicated Follow-up Prognosis Rudimentary, type-B postaxial polydactyly: Good Other types of polydactyly (type A, duplicated thumb): Possible risk of angular[orthopaedicclinic.com.sg]

Etiology

  • […] suggests that the foot is duplicated and the supernumerary toes do not have to be in the mirror duplication. [8] Khan et al. stated that diplopodia has to be differentiated from polydacyly, where accessory tarsal or metatarsal bones are not seen. [13] Etiology[ijoonline.com]
  • The etiology of sporadic PPD1 remains largely unknown and the relative contribution of genetic and environmental factors is not clearly defined.[bmcpediatr.biomedcentral.com]
  • Etiology The cause is unknown, unless the condition is associated with a syndrome.[orthopaedicclinic.com.sg]
  • Etiology The origin of polydactyly appears to be genetic. Thirty-nine percent of patients’ charts that Venn-Watson reviewed noted a positive family history of polydactyly ( 3 ).[musculoskeletalkey.com]
  • On the right foot a possible explanation of the etiology of polymetatarsia without a supernumerary digit would be contiguity fusion of over-induced phalanges after induction of excess digital rays which would lead to thickening phalanges [5,17].[faoj.org]

Epidemiology

  • VI: Duplicated metacarpal Central Postaxial (involving small finger or toe): Type A: Complete duplication with bony attachment to an adjacent digit Type B: Rudimentary, incomplete duplication of the phalanges Synonyms: Accessory digits, Split thumb Epidemiology[orthopaedicclinic.com.sg]
  • The goals of this work are twofold: (1) to examine the clinical features and the epidemiology of sporadic PPD1 in Poland, and (2) to compare epidemiologic characteristics of sporadic PPD1 with the familial forms of isolated polydactyly (more likely attributable[bmcpediatr.biomedcentral.com]
  • They added that diabetes in the mothers pointed to a possible genetic predisposition interacting with teratogenic effects of poor glycemic control. [18] Epidemiology The incidence of polydactyly is 1.7 cases per 1000 live births.[emedicine.medscape.com]
  • Clinical and genetic epidemiology of Bardet-Biedl syndrome in Newfoundland: a 22-year prospective, population-based, cohort study. Am J Med Genet A. 2005;132:352-60. Karmous-Benailly H, Martinovic J, Gubler MC, et al.[rarediseases.org]
  • For instance, a distorted sex ratio in certain syndactylies is very puzzling. 16 Large epidemiological surveys in various populations would be helpful in the evaluation of sex distortion and revisiting the prevalence estimates of various syndactyly types[nature.com]
Sex distribution
Age distribution

Pathophysiology

  • Removing the extra digit through disarticulation is the standard treatment. [4, 11, 12, 13] Pathophysiology Polydactyly may be divided into three broad categories as follows: Postaxial polydactyly (lateral ray) Preaxial polydactyly (medial) Central polydactyly[emedicine.medscape.com]
  • Bardet-Biedl syndrome: Genetics, molecular pathophysiology, and disease management. Indian J Ophthalmol. 2016;64(9): 620-627. Hufnagel RB, Arno G, Hein ND, et al.[rarediseases.org]

Prevention

  • This helps prevent scarring and shortening of tissue, called contractures. The length of time a child wears a splint varies, depending on the severity of the condition.[nyulangone.org]
  • The expression of SHH gene in the posterior region is promoted by polarity, which prevent cleavage of GLI3 into its suppressed form.[news-medical.net]
  • If there is flat foot then a shoe insert may help to prevent its progression. Surgery may be recommended only in severe cases.[cityortho.co.uk]
  • . • Splints or Pads: Specific pads may prevent pressure and physical irritation in shoes. Polydactyly Reconstruction Surgery in the Foot Depending on the toe involved and severity there are various approaches to fixing the problem.[bunionsurgeryny.com]
  • - any amount of varus is considered abnormal, and the patient's symptoms often correlate w/ the degree of varus; - patient's often note difficulty w/ shoe wear and pain; - if hallux varus deformity is present, then consider an AFO which is molded to prevent[wheelessonline.com]

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