FUSED TOES

The medical term for two or more fingers or toes that are fused together or “” is syndactyly (sin-dak-tuh-lee). If your child has this condition, it was present at birth. Webbed fingers or toes are fairly common and often run in families.

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Fused Toes

Fused Toes One of the first things proud parents do after their child is born is to count his or her fingers and toes. What happens if those digits appear fused or stuck together? This disorder is known medically as syndactyly. It happens when skin fuses two or more fingers or toes, giving them a “webbed” appearance. Each person is affected differently by webbed fingers or toes. Here’s what parents should know about the different types of webbing that affect fingers and toes, as well as some of the most common causes, risk factors, and treatments.

What is Webbed Toe

Syndactyly is a rare condition in humans in which fingers or toes are joined together. Such a condition (connected only by skin) is normal in terrestrial mammals such as kangaroos, dogs, and cats, as well as many water-habitat birds such as ducks and amphibians such as frogs. A similar condition in humans is rare, and it is even rarer for the fingers or toes connected by bones. This condition affects approximately one in every 3000 children.

All of the fingers and toes in humans fuse during the first stage of prenatal development. Cell death, on the other hand, occurs as a normal and controlled part of an organism’s growth or development during the first 6-8 weeks. The webbing disappears at this stage due to an enzyme dissolving the tissue between the digits. To date, the exact cause of webbed fingers and toes is unknown in only a few cases.

Because relatives frequently share this condition, doctors believe that the cause points to genetically acquired traits. Therefore, doctors see members of the same family with syndactyly.

Fused Toes Symptoms‌

Webbed toe symptoms can appear as simple or complex. Webbed toe symptoms can also appear complete or incomplete. When fusion occurs all the way to the tip of the toes, this is referred to as complete syndactyly. Incomplete syndactyly occurs when the fusion occurs only partially. For children with webbed fingers or toes, each child will experience a unique set of symptoms:

Unilateral or bilateral: Affecting only one or both sides of the body.
Severe, moderate, or mild: Digits that are almost entirely fused, partially fused, or have only minor webbing between digits.
Symmetric or asymmetric: Appearing similarly and in the same region on both sides of the body, or appearing dissimilarly or in different locations on each side of the body.
Simple or complex: Only two digits or a few bones, or multiple digits or bones.
Intense or asymptomatic.

Minor cases may not impair toe or foot movement or function significantly. In the case of excessively webbed or fused toes, doctors see some children who cannot walk or run properly.

QUESTIONS AND ANSWERS

What constitutes syndactyly (fused toes) in children, and what causes it?

Syndactyly, a congenital condition in which two or more toes are fused together due to incomplete separation, occurs during fetal development. This happens early in pregnancy when the digits form. It can affect either the soft tissues (skin and tissue) or the bones of the toes. Doctors do not know the exact cause of syndactyly, but doctors know that it can result from genetic factors, environmental influences, or a combination of both.

How do doctors diagnose and treat syndactyly in children?

Doctors use tried-and-true technology to diagnose syndactyly. X-rays will help evaluate the extent of fusion, including the involvement of bones. Treatment options depend on the severity and extent of fusion. If the toes appear fused at the skin level and don’t cause functional issues, doctors will sometimes just watch the child. However, if the fusion affects mobility or causes discomfort, doctors will conduct surgical separation.

Surgery may be considered in select cases where the webbing of the toes goes beyond minor cosmetic concerns. For instance, if the condition impedes walking, running, or other physical activities, surgical intervention becomes necessary. Additionally, discomfort or pain due to the fusion is another factor prompting the decision for surgery.

Ultimately, the decision to perform surgery is based on a careful evaluation of the child’s specific needs and the potential benefits versus risks of the procedure.
The surgery involves separating the fused toes, reconstructing the skin, and sometimes adjusting the bones to create a more functional and aesthetically pleasing appearance.

What is the outlook for children with fused toes, and can they lead a normal life?

The outlook or future for children with fused toes appears generally good, especially with appropriate medical intervention. Surgical separation of the fused toes can significantly improve foot function and appearance. Children can lead normal, active lives after the surgical procedure and rehabilitation. It’s important to follow post-surgery care instructions, including wound care, keeping the foot elevated, and attending follow-up appointments. Regular monitoring by healthcare professionals helps ensure proper healing and address any concerns. With early intervention and proper care, most children with fused toes can achieve functional and cosmetic improvement.

Schedule an appointment to have your child, teenager, or adolescent seen at Medical City Children’s Orthopedic and Spine Specialists for fused or webbed toes.

The Impact of Sports on Foot Health

Engaging in sports can significantly affect your foot health. While regular activity is essential for overall well-being, it’s crucial to understand how different sports can impact your feet and ankles. Here’s a closer look:

Running and Track

Running is a fantastic cardiovascular exercise, but it can also lead to stress on the feet and ankles. The repetitive motion can cause problems like plantar fasciitis and Achilles tendinitis. Ensuring proper footwear and incorporating strength-training exercises can help mitigate these issues.

Soccer

Soccer requires agility, quick direction changes, and sustained running, which can lead to injuries such as sprained ankles and stress fractures. Wearing well-fitted cleats and practicing proper techniques can go a long way in preventing these common soccer-related foot injuries.

Basketball and Tennis

These sports involve frequent jumping and rapid lateral movements, putting significant pressure on the ankles and feet. Ankle sprains and overuse injuries like tendinitis are common. Supportive shoes with good cushioning and ankle support are vital.

Football and Rugby

The physical contact and abrupt movements in football and rugby increase the risk of severe foot and ankle injuries, including fractures and sprains. It’s essential to wear protective gear and ensure playing surfaces are free of hazards.

Low-Impact Options

For those looking for lower-impact sports, consider golf or volleyball. These activities still promote fitness without the high risk of injury to the foot and ankle commonly associated with more intense sports. However, proper footwear remains essential.

Preventive Measures

Invest in Quality Footwear: Proper sports-specific shoes are crucial for support and injury prevention.
Warm-Up and Stretch: Preparing your muscles and ligaments can reduce the risk of sprains and strains.
Strength and Flexibility Training: Incorporate exercises that enhance foot and ankle strength and flexibility.
Rest and Recovery: Allow time for rest to prevent overuse injuries.

In summary, while sports are an excellent way to stay fit, being mindful of the demands each activity places on your feet and taking precautions can help maintain optimal foot health.

Common Sports-Related Foot and Ankle Injuries

Whether you’re an athlete or just enjoy an occasional game, foot and ankle injuries can occur across various sports. These injuries vary greatly depending on the activity, but here’s a breakdown of some common ones:

Baseball and Softball

Fast-paced running and sudden directional changes can lead to sprains or stress fractures. Sliding into bases heightens the risk of ankle twists and strains.

Basketball

Jumping and rapid shifts in movement are trademark features of basketball, often resulting in injuries like Achilles tendonitis, ankle sprains, and plantar fasciitis.

Football and Rugby

These contact sports often lead to more severe injuries. High-impact collisions can cause fractures, torn ligaments, and severe sprains.

Soccer

Kicking and swift maneuvers make soccer players prone to metatarsal fractures, ankle sprains, and tendonitis.

Running and Track

Repetitive stress from running can lead to overuse injuries such as shin splints and stress fractures in the foot and ankle.

Tennis

Quick pivoting and lateral movements are staples in tennis, leading to common injuries like Achilles tendonitis and ankle sprains.

Golf

While often seen as lower-impact, golf isn’t free from injuries. The repeated swing motion can stress ligaments in the feet and result in plantar fasciitis.

Volleyball

Volleyball players are susceptible to ankle sprains and fractures due to frequent jumping and landing.

Understanding these potential injuries is crucial for prevention and optimal performance. Whether you’re on the field, court, or track, taking preventative measures such as proper warm-ups and supportive footwear can make a significant difference.

The Impact on Foot Health

Alignment and Balance: Proper orthotics ensure your feet are aligned properly, which can prevent issues not just in the feet but in the knees, hips, and back.
Pressure Relief: By distributing pressure evenly across your feet, orthotics can reduce the strain on specific areas, preventing calluses and ulcers.
Injury Prevention: High-quality footwear and the right support can drastically reduce the risk of injuries such as sprains and fractures.

Choosing the Right Footwear

Ensure a proper fit; shoes should accommodate your orthotics without being too tight.
Look for features like arch support, adequate cushioning, and a robust sole to absorb shock.
Prioritize materials that allow breathability to keep your feet dry and comfortable.

By choosing the right combination of orthotics and supportive footwear, you can promote better foot health, enhance mobility, and lead a more active lifestyle. Prioritizing these aspects in your daily routine will not only help manage existing problems but also prevent new issues from arising.

Fused Toes Causes

While developing in the womb, a child’s hand takes the shape of a paddle. About the sixth or seventh week of pregnancy, the hand starts to divide and develop fingers. Webbed fingers fail to effectively complete this procedure, resulting in fused-together digits. Webbing of the fingers and toes happens at random and for no apparent reason. It is less commonly caused by an inherited trait. Doctors find webbing to also link to genetic conditions like Down Syndrome and Apert Syndrome. Both syndromes refer to genetic disorders that can result in abnormal bone growth in the hands.

The cause of webbed toes is generally unknown. However, doctors believe the cause points to a congenital condition, meaning an inherited condition. Sometimes, it is associated with other conditions. Doctors estimate that 10% to 40% of people with syndactyly have webbed fingers and toes in their families, indicating a possible genetic component.

Webbed fingers and toes are usually an isolated birth defect, but understanding the potential causes can provide clarity and guidance for further exploration with healthcare professionals.

Fused Toes Diagnosis

With today’s technology, doctors can detect syndactyly during a prenatal ultrasound. Following the birth of the child, the physician will conduct a physical examination and discuss the symptoms with the patient and their families to make a diagnosis. The doctor will look for signs of other conditions that could cause the syndactyly. In most cases, surgeons can surgically correct webbed toes, and this usually happens between the ages of 12 and 18 months before full development has occurred. Doctors prefer to treat webbed toes before they cause joint malformation.

Typically, a doctor will order an X-ray or ultrasound of the webbed area to determine which structures are involved and the best surgical approach. They may also order blood tests and chromosomal tests to see if the webbing is related to another condition or is syndromic, especially if the child has other physical symptoms of a genetic syndrome. The surgical procedure used to correct webbed toes is determined by the severity of the webbing and the structures involved.

Treatment Options

Most patients experience different treatment options. Some types of syndactyly have a well-established genetic basis, and therefore, most people consider webbed toes as an inherited condition. However, because each case is unique, researchers still do not understand the full range of factors that cause the condition to develop. According to available research, boys are more likely than girls to develop syndactyly. Furthermore, Caucasian children seem more likely than children of other ethnic backgrounds to develop webbed digits.

Although it can affect any toe or the spaces between them, syndactyly most commonly occurs between the second and third toes. However, it’s important to note that webbed toes, also known as syndactyly, can appear between any of the toes. While the second and third toes are the usual culprits, this condition isn’t exclusive to them, highlighting the diverse nature of this congenital anomaly.

Nonsurgical syndactyly treatment

Some children with mild syndactyly may never require surgery. This is usually reserved for syndactyly affecting the toes. Your provider will determine whether your child requires surgery to separate their digits. It is unusual for children not to need syndactyly surgery on their fingers because anything that limits their ability to move can create an impact on the overall function of their child’s hand. It is impossible to prevent genetic conditions such as syndactyly from developing during pregnancy. However, syndactyly and other genetic conditions are linked to environmental factors such as:

Drinking alcoholic beverages.
Using tobacco products or smoking.
Using drugs for fun.

Understanding the Role of Orthotics and Footwear in Foot Health

Foot health is crucial for overall well-being, and the right orthotics and footwear can significantly enhance comfort and mobility. Here’s how they contribute:

Custom Orthotic Devices

Custom orthotic devices are specially designed to fit the unique contours of an individual’s feet. They address specific issues such as arch support, alignment, and pressure distribution. By providing a tailored solution, they can alleviate pain, reduce the risk of injury, and enhance overall foot function.

Shoe Inserts

Shoe inserts, often available over-the-counter, offer additional support and cushioning. They are an affordable option for improving comfort and can help with common foot problems such as plantar fasciitis or general discomfort from prolonged standing.

Surgical Procedure

Once the child is sleeping, the surgeon will cut through the webbing in a zigzag pattern along the midline point. This method of cutting the webbing will help to prevent scarring from interfering with healthy growth and development. If any structures other than the skin are fused, the surgeon will divide them as they make the zigzag cuts. The surgeon will sometimes sew skin grafts, or transplanted pieces of healthy skin, over the exposed wounds to protect them as they heal. This will also help to reduce scarring by reducing tension as the wound heals. Skin grafts are usually taken from the child’s inner groin or the back of the upper arm.

They will next set the repaired toes in a cast that will cover and immobilize them to prevent further harm while they recover, or they may wrap the injured region in many layers of bandages. Most surgeries to repair webbed digits last 2-5 hours. Surgeons are very successful in treating Syndactyly in the vast majority of cases. Depending on the extent of the procedure, it usually takes a month or so for children to put pressure on the separated toes and 3-6 months for them to fully heal. Because webbed toes can disrupt development, lead to disability, and possibly cause self-esteem issues, most insurance plans cover a portion of the cost of this corrective surgery.

After Fused Finger Surgery

Following surgery, the doctor will put the hand in a cast. The doctor will remove the cast after about 3 weeks and replace it with a brace. A rubber spacer can also keep their fingers separate while sleeping. They’ll also most likely need physical therapy after surgery to help with things like:

The range of motion

Your child will need to see their healthcare provider regularly to monitor the healing of their fingers and toes. Their healthcare provider will ensure that the incisions heal properly during these checkups. They’ll also look for web creep, which occurs when the webbed area grows after surgery. Based on the results of the evaluation, their healthcare provider will decide whether your child requires additional surgeries. The majority of children will need to stay in the hospital for a few days following surgery. On the toes, there is usually some bruising, swelling, and nail discoloration. Children are likely to require pain medications after being discharged from the hospital.

Outlook

Fortunately, most children can function normally after surgery when using their newly separated digits. Parents should collaborate with their child’s healthcare team. The doctors at Medical City Children’s Orthopedics and Spine Specialists will assist the parents in ensuring that their child achieves the best results possible.

The orthopedic doctors at Medical City Children’s Orthopedics and Spine Specialists have offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX, and specialize in Children. As specialists, Doctors Richard Hostin, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, treat children for minor and major medical problems. In addition, we invite new patients to call and make an appointment. Also, we will see your child quickly and find a solution to get your child back to being a kid.

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Footnote:

National Library of Medicine: Syndactyly

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at five convenient locations: Arlington, Dallas, Flower Mound, Frisco and McKinney.