WEBBED FINGERS AND WEBBED TOES
The medical term for two or more fingers or toes that are fused together or “webbed” is syndactyly (sin-dak-tuh-lee). If your child has it, it was present at birth. Webbed fingers or toes are fairly common and often run in families.
Syndactyly occurs when tissue connects two or more digits together. In some rare instances, the connection may include bone. This condition is more prevalent than you might think, with approximately 1 in every 2,000–3,000 babies born with webbed fingers or toes. It is most commonly observed in white males, adding a demographic perspective to its occurrence.
Understanding these nuances can help in anticipating the needs and potential treatments for those with syndactyly, ensuring they receive proper care and support. At the Medical City Children’s Orthopedics and Spine Specialists Medical Practice, we have Webbed Fingers and Webbed Toes Doctors to successfully treat your child.
If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.
Webbed Fingers and Webbed Toes
The abnormal connection of two fingers refers to a medical term called syndactyly. This condition occurs most often between the middle and ring fingers. It can, however, involve any two fingers or the thumb and pointer finger. Also, webbed fingers can occur with more than two fingers. The webbing can involve two fingers or just a portion of them.
It could include just the skin or it could involve the bone as well. The majority of syndactyly occurs during the development of the hand and arm while the baby grows in the womb. For instance, the entire arm forms between 4 and 8 weeks of gestation, which means that the hand is in its final shape and form (albeit much smaller!) by about 56 days after the baby is conceived.
The fingers are all webbed during the final developmental stages nearing 40 days and after. Normally, the skin interconnections disappear before 56 days, but if cell signaling does not occur as expected, the skin connections (the webbing) remain, which is referred to as “syndactyly.” In most cases, neither the mother nor father did anything to cause the abnormality, nor could they have done anything to prevent it.
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.
Causes of Webbed Fingers and Webbed Toes
While developing in the womb, a child’s hand takes the shape of a paddle.
- It happens when the toes or fingers fail to separate properly during fetal development. Syndactyly can also occur after a significant injury, such as a burn, when the skin or another body structure fails to heal properly. Because syndactyly frequently expresses as webbing, the condition is commonly referred to as webbed toes or fingers.
- The majority of webbed toes are caused by the skin failing to separate during fetal development. Around the sixth or seventh week of pregnancy, the hand begins to split and form fingers. In the case of webbed fingers, this process fails, resulting in digits that are fused together.
- Webbing of the fingers and toes happens at random and for no apparent reason. It is less commonly caused by an inherited trait.
- Doctors believe that Webbing links to genetic conditions like Down syndrome and Apert syndrome. Both syndromes are genetic disorders that can result in abnormal bone growth in the hands.
QUESTIONS AND ANSWERS
What causes webbed fingers or toes, and is it a serious concern?
Webbed fingers or toes, also known as syndactyly, occur when the skin and tissues between digits do not separate completely during fetal development. The exact cause may be genetic or influenced by environmental factors. In many cases, syndactyly does not present a serious medical concern and does not affect the overall health of the child. However, the severity and impact on function can vary. A thorough examination and, if necessary, imaging studies can help determine the extent of the syndactyly and its potential effects.
Can webbed fingers or toes be corrected, and what does the treatment involve?
The possibility of correction depends on the extent of the syndactyly and whether it affects function or causes cosmetic concerns. Surgical intervention occurs as an option to separate the fused digits. The timing of surgery may vary, but it occurs in early childhood. The procedure involves cutting and reconstructing the tissues to create separate fingers or toes. The specific surgical approach will depend on the individual case and the surgeon’s recommendations.
Will my child face any long-term challenges or complications due to webbed fingers or toes?
In many cases, children with syndactyly who undergo corrective surgery can go on to lead normal, healthy lives with little to no long-term impact. The success of the treatment and the potential for any complications depend on the severity of the syndactyly, the surgical approach, and individual factors. Regular follow-up with healthcare professionals remains a priority to monitor the child’s progress and address any concerns that may arise.
Children who receive surgical intervention often experience good function and movement in the treated foot or hand, with the digits growing as expected. It’s important to note that while untreated webbed toes typically do not cause significant issues, untreated webbed fingers can negatively affect hand functionality and dexterity throughout a person’s life.
Thus, the decision to pursue surgery should consider the potential impacts on daily activities and quality of life. Engaging with a skilled medical team ensures the best possible outcome, tailoring the approach to the unique needs of each child.
It’s crucial for parents to conduct open and honest discussions with their child’s doctor, ask questions, and understand the specific details of their child’s condition. A multidisciplinary approach involving pediatricians, orthopedic surgeons, and other specialists may be involved in the assessment and management of webbed fingers or toes.
The doctors at Medical City Children’s Orthopedics and Spine Specialists, are experts in treating and fixing webbed fingers and webbed toe abnormalities. Call us for an appointment.
Webbed Fingers and Webbed Toes Symptoms
As webbed toes may be, each person with syndactyly has 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, children can become incapacitated.
Types of Syndactyly
Webbed digits are classified into several types, each distinct in how the fusion is presented. Understanding these classifications can help in determining the appropriate course of action. Here’s a comprehensive overview:
Simple Syndactyly
Only soft tissue and skin connect adjacent fingers or toes. This is the most common form of syndactyly and typically involves a straightforward surgical correction.
Complex Syndactyly
This type involves the fusion of bones, nerves, and blood vessels between the digits. It’s more intricate due to the additional structures involved, necessitating a more detailed surgical approach.
Complicated Syndactyly
In this rare condition, the fused fingers or toes include extra bones, tendons, or ligaments. The presence of additional anatomical structures makes the treatment more challenging.
Complete Syndactyly
The skin is joined all the way down the digits, from the base to the tip. This complete fusion may require comprehensive surgical planning to separate the digits successfully.
Partial Syndactyly
The skin is only joined halfway up the digit, usually to the first joint. This partial connection often involves a less complex surgical procedure compared to complete syndactyly.
Fenestrated Syndactyly
The skin is joined for the majority of the digit, but there is a gap in the middle. This unique characteristic can influence the surgical technique used for separation.
Polysyndactyly
An additional digit is webbed to an adjacent digit. This condition combines extra digits with webbing, creating a unique set of challenges in treatment and correction. By understanding these varied forms of syndactyly, medical professionals can tailor interventions to each specific case, ensuring the best outcomes for function and appearance.
By understanding these classifications, you can gain a clearer picture of the variations in webbed digits and their fusion extents, providing valuable insights into diagnosis and treatment options.
Children at Risk for Webbed Fingers and Webbed Toes
Most cases of syndactyly arise without a clear cause, something simply alters bone or soft tissue development while the baby is still in the womb. However, in some instances, a child may inherit a gene mutation from a parent that leads to webbed digits. There are currently 300 different syndromes associated with syndactyly, the majority of which are genetic conditions. Among the most common are:
- Congenital constriction band syndrome
- Cornelia de Lange syndrome
- Craniofacial abnormalities
- Fetal hydantoin syndrome
- Down syndrome (trisomy 21)
- Poland syndrome
- Smith-Lemli-Opitz syndrome
- The Apert syndrome
- The Crouzon syndrome
Understanding these patterns and associations can help families and healthcare providers anticipate the needs and care pathways for children born with syndactyly.
Some types of syndactyly have a well-established genetic basis, and most people would consider webbed toes an inherited condition. However, because each case appears unique, researchers still do not understand the full range of factors that cause the condition to develop.
In most cases, surgeons can separate 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.
Children with syndactyly typically function well, although the more fingers affected, the more difficult it will be for conducting some simple functions. The main functional issue with syndactyly is grabbing large objects or circular objects (because the fingers do not spread apart as well as they should). Untreated webbed toes do not typically cause problems and generally allow for normal foot use. However, untreated webbed fingers can negatively affect how well a person can use their fingers and hands throughout their lives. This is especially true for tasks requiring fine motor skills and dexterity.
Surgical Treatment Options
Surgery is often considered when non-surgical treatments are not sufficient or if the webbing limits function or causes psychosocial concerns. The procedure, known as syndactyly release or de-syndactylisation, typically involves separating the fused digits and may require a skin graft—often taken from another part of the body such as the ankle—to cover the newly separated areas.
The timing of surgery is important. Early intervention, generally between 12 and 18 months of age, helps prevent potential joint deformities and supports normal hand or foot function as the child grows. However, the decision to operate is individualized and takes into account the child’s age, overall health, and the specific characteristics of the syndactyly.
What to Expect After Surgery
Following surgery, a period of immobilization and careful monitoring is necessary to ensure proper healing and minimize scarring. Occupational or physical therapy may be recommended to help restore movement, strength, and coordination, especially when the hands are involved. With appropriate care, most children regain good function and experience improved appearance and self-confidence.
Syndactyly Changes
Syndactyly changes the appearance of the hand. This may bother the child and alter how others perceive the child. This may cause stress and low self-esteem in some children.
By addressing both the functional and emotional aspects, understanding the full impact of syndactyly allows for a more comprehensive approach to treatment and support.
When exploring the related limb differences associated with syndactyly, you’ll find that this condition often presents alongside several congenital variations. Here are the common ones:
- Polydactyly: This involves the presence of extra fingers or toes, which can occur alongside the webbing typical in syndactyly.
- Symbrachydactyly: In these cases, fingers or toes may be shorter or underdeveloped, offering another layer of complexity to the limb formation.
Understanding these conditions helps in recognizing the diversity of congenital limb differences that may accompany syndactyly, each presenting its own unique characteristics.
Discovering the Problem
If your child is born with webbed fingers and/or toes, the doctor will look for other signs to see if your child has a more serious condition. 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.
Diagnosing Syndactyly:
- Prenatal Detection: Sometimes, syndactyly can be detected before birth through a prenatal ultrasound. This imaging test can identify physical anomalies, including webbed digits, allowing for early preparation and consultation with specialists.
- Post-Birth Observation: More commonly, syndactyly is noticeable immediately after birth. Doctors can visually identify webbed toes or fingers, prompting further diagnostic steps.
- X-Ray Examination: An X-ray is crucial in determining the type and extent of the fusion. It helps clarify which bones and tissues are involved, guiding subsequent medical decisions.
- Genetic Testing: A genetic test, often a blood test, may be ordered to check for gene mutations or conditions that might cause syndactyly. This is especially important if there are other symptoms present that could indicate a broader genetic syndrome.
The surgical procedure used to correct webbed toes is based on the severity of the webbing and the structures involved. One of the most common types of birth abnormalities is syndactyly, which causes webbed or fused toes or fingers. Researchers do not know why webbed digits develop, but there is a clear genetic cause in some cases.
Typical Surgical Procedure
Before surgery begins, anesthesia is administered—either general anesthesia or sedation—based on what is safest and most comfortable for your child. Once the child becomes unconscious, the surgeon will usually 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 carefully as they make the zigzag cuts. To protect the exposed wounds while they heal, the surgeon at Medical City Children’s Orthopedics and Spine Specialists may stitch skin grafts, or transplanted pieces of healthy skin, over the top.
This will also help to reduce scarring by relieving tension as the wound heals. Skin grafts are typically taken from the child’s inner groin or the back of the upper arm. They will then wrap layers of bandages around the affected area or place them in a cast that will cover and immobilize the corrected toes to keep them safe while they heal. Most surgeries to repair webbed digits last between 2 and 5 hours.
Preparing for Surgery
Before your child’s surgery for webbed toes, there are important preparatory steps to ensure the procedure goes smoothly and safely:
- Consultation and Evaluation: The process typically begins with an in-depth evaluation and discussion with your child’s orthopedic specialist. This allows the surgeon to understand your child’s individual needs and determine the most appropriate approach for surgery.
- Diagnostic Imaging: Your child’s doctor may recommend weight-bearing X-rays before the consultation. These images provide a clear picture of the bones involved, enabling the surgical team to plan the most effective way to separate the fused toes or fingers. In complex cases, a CT scan or MRI might also be suggested for better visualization of soft tissues.
- Medical Clearance: A thorough health check is conducted to assess your child’s readiness for anesthesia and surgery. This may include reviewing your child’s medical history, a physical examination, and standard blood tests.
- Remote Consultations: If in-person appointments are a challenge due to distance, some specialists offer initial telemedicine consultations. You may be asked to submit photos or digital copies of your child’s X-rays prior to the visit, making it easier for the surgeon to assess the condition remotely and advise on next steps.
These preoperative measures help ensure the surgeon has all the necessary information to safely proceed, and give you the opportunity to ask any lingering questions about the procedure, recovery, or what to expect on surgery day.
Lifestyle Changes Before Surgery
Before your child’s surgery, making certain lifestyle adjustments can play a big role in ensuring a smooth procedure and healthy recovery. One of the most important recommendations is to quit smoking well in advance of the operation—ideally, at least four weeks before the scheduled date. Exposure to nicotine and other chemicals in cigarette smoke can interfere with wound healing, increase the risk of post-surgical complications, and slow the body’s recovery process.
If you’re looking for support to help you or a family member quit smoking, organizations like the
Eating a balanced diet, keeping up with hydration, and ensuring all medications and supplements are reviewed with your doctor are also valuable habits leading up to surgery. Making these adjustments ahead of time can help set your child up for a smoother recovery and long-term health.
After Surgery Recovery
Following surgery, the doctor will place the child’s hand in a cast. After about three weeks, the doctor will remove the cast and add a brace. A rubber spacer can also keep their fingers apart while sleeping. They’ll also most likely need physical therapy after surgery to help with things like:
- Stiffness
- The range of motion
- Swelling
Your child will need to see their healthcare provider on a regular basis to monitor the healing of their fingers and toes. Their healthcare provider will ensure that the incisions have healed 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 determine whether your child requires additional surgeries.
Most children are able to function normally after surgery when using their newly separated digits.
Typical Recovery Timeline
While every child heals at their own pace, here’s a general guide to what you can expect during recovery:
- Rest: For the first 1–2 weeks, your child should limit activity, using their hand or foot only for essential tasks.
- Movement: Between 3–4 weeks post-surgery, gentle movement around the house is usually allowed, but activity outside should remain minimal.
- Return to Sedentary Activities: If your child attends school or participates in quiet activities, they may be able to return in 1–2 weeks, provided they can keep the limb elevated and avoid strenuous use.
- Physical Therapy: Low-impact exercises and therapy, such as gentle stretches or supervised play, often begin around 4–6 weeks to restore flexibility and strength.
- More Active Play: High-impact activities—including running, jumping, or sports—are typically delayed until 6–8 weeks after surgery, depending on healing and the advice of your child’s healthcare provider.
Regular follow-up appointments are essential to monitor progress and catch any complications early. Remember, every child’s recovery is unique, and your doctor will tailor recommendations based on your child’s specific needs.
Parents should collaborate with your child’s healthcare team. They will assist you in ensuring that your child achieves the best results possible. However, some differences may still be visible when comparing digits that underwent surgery to those that did not. As a result, some children may experience low self-esteem. If you notice your child has low self-esteem, consult with their doctor.
They can guide you to community resources that provide additional support. Consider reaching out to local support groups where members understand your experiences and can offer valuable insights. These groups can be a source of encouragement and practical advice, helping your child build confidence in a supportive environment.
By accessing both medical advice and community support, you can address self-esteem issues more comprehensively, ensuring your child receives the care and understanding they need.
What to Expect During Recovery
Immediate Care:
After surgery, your child should rest and keep the operated hand or foot elevated as much as possible to minimize swelling and discomfort. Pain medication will be prescribed as needed—be sure to follow dosage instructions carefully. It’s important to keep the cast dry; covering it with a plastic bag during bathing is usually recommended.
First Few Weeks:
For the first 2–3 weeks, activity should be kept to a minimum. The cast provides protection and promotes proper healing, so avoid activities that could bump or injure the area. Walking or using the hand should be limited to essential activities only.
Transition Phase:
Once the cast is removed, the doctor may fit your child with a brace or splint. A rubber spacer may also be used at night to maintain separation of the digits while sleeping. Physical therapy often begins at this stage to gradually restore range of motion and decrease stiffness or swelling.
Returning to Normal Activities:
- Sedentary activities: Children may return to school or desk-based work within 1–2 weeks after cast removal, provided they can keep the affected area protected and elevated.
- Active play and sports: Full participation in physical activities, running, or sports is typically delayed for 6–8 weeks, depending on healing progress and the doctor’s recommendations.
- Low-impact activities: Gentle stretching, slow walking, or light play may be encouraged after 4–6 weeks as comfort and healing allow.
When to Call the Doctor
Contact your healthcare provider immediately if you notice:
- Severe pain not relieved by medication, rest, or elevation
- Bandages or cast becoming saturated with blood
- Changes in skin color (pale, blue, or very red) of the fingers or toes
- Any signs of infection, like fever or foul odor
- Any accidental injury to the healing area
Full recovery can take anywhere from 8–10 weeks, and your child’s doctor will set up regular follow-up appointments to monitor healing and address any concerns.
Complications of Surgery for Webbed Fingers and Webbed Toes
Unfortunately, scarring occurs after the surgery, and the webbing grows back on occasion. Post-operative swelling, severe pain, numbness, bluish discoloration, and tingling toes are all possible. If any of these symptoms appear, you should immediately contact your doctor or surgeon Additional issues that may arise include:
- Skin graft damage may darken with time.
- Breathing difficulties
- Intubation-related sore throat.
- Excessive bleeding.
- Negative reaction to medications
- A second surgery may occur (depending on the type of syndactyly).
Because most skin grafts are taken from the thigh, the graft may eventually grow hair. This is a purely cosmetic issue, as the hair can be easily removed with tweezers.
Why Choose Medical City Children’s Orthopedics and Spine Specialists
Finally, our doctors at Medical City Children’s Orthopedics and Spine Specialists, with offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX understand the importance of maintaining your child’s health. In addition, our experts and specialists have the training, knowledge, and experience required to treat children with mild to severe conditions. If your child has either webbed toes or fingers, don’t hesitate to call our office to schedule an appointment to get a proper diagnosis at one of our five locations.
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Footnote:
Call 214-556-0590 to make an appointment.