Ray Reduction of the Foot in the Treatment of Macrodactyly and Review of the Literature


      Macrodactyly of the foot is a rare disorder characterized by enlargement of the soft tissue and osseous elements of the foot that impedes the development of normal function and gait. Despite the morbidity associated with this condition, many surgeons are reluctant to perform surgical reduction. In the present report, we describe 3 pediatric patients with pedal macrodactyly, who underwent surgical correction consisting of amputation of the most enlarged ray, reduction of the adjacent rays, and ray transposition, combined with debulking of soft tissues. All 3 patients subsequently developed a normal gait and were able to wear normal, or minimally adjusted, shoes. We advocate early surgical treatment of macrodactyly of the foot to enhance the development of normal function and gait.

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        • Chang C.H.
        • Kumar S.J.
        • Riddle E.C.
        • Glutting J.
        Macrodactyly of the foot.
        J Bone Joint Surg Am. 2002; 84-A: 1189-1194
        • Barsky A.J.
        J Bone Joint Surg Am. 1967; 49: 1255-1266
        • Turra S.
        • Santini S.
        • Cagnoni G.
        • Jacopetti T.
        Gigantism of the foot: our experience in seven cases.
        J Pediatr Orthop. 1998; 18: 337-345
        • Sobel E.
        • Giorgini R.J.
        • Potter G.K.
        • Schwartz R.D.
        • Chieco T.M.
        Progressive pedal macrodactyly surgical history with 15 year follow-up.
        Foot Ankle Int. 2000; 21: 45-50
        • Krengel S.
        • Fuster-Morales A.
        • Carraco D.
        • Vazquez M.
        • Duran-McKinster C.
        • Ruiz-Maldonado R.
        Macrodactyly: report of eight cases and review of the literature.
        Pediatr Dermatol. 2000; 17: 270-276
        • Temtamy S.A.
        • Rogers J.G.
        Macrodactyly, hemihypertrophy, and connective tissue nevi: report of a new syndrome and review of the literature.
        J Pediatr. 1976; 89: 924-927
        • Ackland M.K.
        • Uhthoff H.K.
        Idiopathic localized gigantism: a 26-year follow-up.
        J Pediatr Orthop. 1986; 6: 618-621
        • Biesecker L.G.
        • Happle R.
        • Mulliken J.B.
        • Weksberg R.
        • Graham Jr., J.M.
        • Viljoen D.L.
        • Cohen Jr., M.M.
        Proteus syndrome: diagnostic criteria, differential diagnosis, and patient evaluation.
        Am J Med Genet. 1999; 84: 389-395
        • Vaughn R.Y.
        • Selinger A.D.
        • Howell C.G.
        • Parrish R.A.
        • Edgerton M.T.
        Proteus syndrome: diagnosis and surgical management.
        J Pediatr Surg. 1993; 28: 5-10
        • Casanova D.
        • Chabas J.F.
        • Salazard B.
        Les macrodactylies de la main et du pied.
        Chir Main. 2008; 27: S178-S184
        • Barmakian J.T.
        • Posner M.A.
        • Silver L.
        • Lehman W.
        • Vine D.T.
        Proteus syndrome.
        J Hand Surg. 1992; 17A: 32-34
        • Tsuge K.
        Treatment of macrodactyly.
        Plast Reconstr Surg. 1967; 39: 590-599
        • Anderson M.
        • Blais M.
        • Green W.T.
        Growth of the normal foot during childhood and adolescence. Length of the foot and interrelations of foot, stature, and lower extremity as seen in serial records of children between 1–18 years of age.
        Am J Phys Anthropol. 1956; 14: 287-308
        • Turra S.
        • Frizziero P.
        • Cagnoni G.
        • Jacopetti T.
        Macrodactyly of the foot associated with plexiform neurofibroma of the medial plantar nerve.
        J Pediatr Orthop. 1986; 6: 489-492
        • Sabapathi S.R.
        • Roberts J.O.
        • Regan P.J.
        • Ramaswamy C.N.
        Pedal macrodactyly treated by digital shortening and free nail graft: a report of two cases.
        Br J Plast Surg. 1990; 43: 116-119
        • Kotwal P.P.
        • Farooque M.
        J Bone Joint Surg Br. 1998; 80: 651-653
        • Topoleski T.A.
        • Ganel A.
        • Grogan D.P.
        Effect of proximal phalangeal epiphysiodesis in the treatment of macrodactyly.
        Foot Ankle Int. 1997; 18: 500-503
        • McGrory B.J.
        • Amadio P.C.
        • Dobyns J.H.
        • Stickler G.B.
        • Unni K.K.
        Anomalies of the fingers and toes associated with Klippel-Trenaunay syndrome.
        J Bone Joint Surg Am. 1991; 73: 1537-1546
        • Minguella J.
        • Cusi V.
        Macrodactyly of the hands and feet.
        Int Orthop. 1992; 16: 245-249
        • Ishida O.
        • Ikuta Y.
        Long-term results of surgical treatment for macrodactyly of the hand.
        Plast Reconstr Surg. 1988; 102: 1586-1590
        • Kalen V.
        • Burwell D.S.
        • Omer G.E.
        Macrodactyly of the hands and feet.
        Pediatr Orthop. 1988; 8: 311-315