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Polydactyly of the feet in children: suggestions for surgical management.

Polydactyly is the commonest congenital deformity of the foot, presenting as a range of defects from minor soft tissue duplications to major bony abnormalities. There is a relative paucity of information on the management of this condition in the literature compared to that concerning polydactyly of the hand. We present a consecutive series of 34 cases of polydactyly of the foot in 25 patients treated surgically at our unit and these are classified according to the protocol described by Blauth and Olason. We emphasise the importance of preoperative classification using radiographs and an individualised surgical approach giving consideration to aesthetic and functional outcome. In the literature a number of authors have expressed the view that in polydactyly of the fifth ray of the foot the most lateral digit should always be excised irrespective of whether this is the more fully formed digit. We believe this should not always be the case and we describe two cases of polysyndactyly where the more medial element of a fifth-ray polydactyly was excised to allow for better maintenance of the contour of the foot. This involved more complex surgery than excision of the lateral element but gave a superior cosmetic and functional result.