Case Report| Volume 58, ISSUE 4, P814-820, July 2019

Download started.


Surgical Reconstruction Technique of Two Patients With Tarsal Type Preaxial Polydactyly: Two True Prehalluces


      Polydactyly of the foot occurs in 1.7 cases per 1000 live births, comprising 45% of congenital abnormalities of the foot. Most reported cases of polydactyly of the foot are postaxial, and 15% are preaxial; of those, tarsal type preaxial polydactyly (a true prehallux) occurs in only 3% of cases. Because of this rarity, there is minimal literature available to guide management or surgical reconstruction. Two newborns presented with similar tarsal type preaxial polydactylies in the context of multiple congenital anomalies at a single institution. Patient 1 presented at birth with an accessory digit arising medially from the right foot at the medial malleolus. Two weeks later, genetically unrelated, patient 2 presented at birth with an accessory digit arising medially from the right foot at the talus. Both patients underwent resection of the extra digit and reconstruction including transfer of the accessory anterior tibial tendon arising from the preaxial extra digit to the remaining first ray. Two years after surgery, both patients are walking well with preserved dorsiflexion strength. Given the rarity of true prehallux cases, reported surgical treatment and outcomes are lacking. This case demonstrates the management of 2 patients to better guide future patient care. Although nonsurgical treatment with shoewear modification is an option, surgical reconstruction facilitated wearing typical shoes while preserving ambulatory ability. Both patients in this series had an accessory anterior tibial tendon. Surgical transfer of the tendon prevented loss of dorsiflexion strength and foot drop postoperatively.

      Level of Clinical Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Venn-Watson EA
        Problems in polydactyly of the foot.
        Orthop Clin North Am. 1976; 7: 909-927
        • Phelps DA
        • Grogan DP
        Polydactyly of the foot.
        J Pediatr Orthop. 1985; 5: 446-451
        • Belthur MV
        • Linton JL
        • Barnes DA
        The spectrum of preaxial polydactyly of the foot.
        J Pediatr Orthop. 2011; 31: 435-447
        • Woolf CM
        • Myranthopoulos NC
        Polydactyly in American Negroes and whites.
        Am J Hum Genet. 1973; 25: 397-404
        • Cobey MC
        • Cobey JC
        A true prehallux. The first to be described in the literature.
        J Bone Joint Surg Am. 1966; 48: 953-954
        • Watanabe H
        • Fujita S
        • Oka I
        Polydactyly of the foot: an analysis of 265 cases and a morphological classification.
        Plast Reconstr Surg. 1992; 89: 856-877
        • Rao BR
        Supernumerary toe arising from the medial cuneiform. A case report.
        J Bone Joint Surg Am. 1979; 61: 308
        • Jalili A
        Preaxial polydactyly of foot, report of a rare case.
        Shafa Ortho J. 2014; 1: e24623
        • Okumoto T
        • Aramaki-Hattori N
        • Taguchi Y
        • Inoue Y
        • Matsuzaki K
        • Kishi K
        A case report of true prehallux.
        JPRAS Open. 2015; 4: 26-29
        • Granite G
        • Herzenberg J
        • Wade R
        Rare case of tibial hemimelia, preaxial polydactyly, and club foot.
        World J Clin Cases. 2016; 4: 401-408
        • Kidner FC
        The prehallux (accessory scaphoid) in its relation to flat-foot.
        J Bone Joint Surg. 1929; 11: 831