Webbed Toes

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    If you’re having trouble dealing with webbed toes, there’s no need to worry. If Ashton Kutcher can live with it, so can you.

    Webbed toes, or syndactyly, is the occurrence of two or more fused digits of the hands or feet. Boston Children’s Hospital records that 1 in every 2,500 babies are born with this condition making it a common occurrence.

    Syndactyly is commonly caused by faulty apoptosis (cell death) during gestation. Initially, the hands and feet form in the shape of a paddle while still in the womb, so webbed digits are natural during early fetal development. At 6-8 weeks, the digits separate but faulty enzyme action may cause incomplete separation during this time, causing the webbing.

    Rare conditions present with fusion at the bones. There may also problems with the phalanges of the joined digits such as extra or misshaped. Digits may also be joined at the muscles, tendons, nerves, and blood vessels.

    In most cases, webbing happens at random, usually attributed to heredity. Syndactyly is also related to genetic defects like Down syndrome and Apert syndrome.

    Types of webbing that could occur in syndactyly cases:

  1.  Simple- when adjacent toes are joined together by soft tissue and skin only.
  2.  Complex- when it is the adjacent bones that are fused together.
  3.  Complete- when the entire length of the digits are joined together by skin.
  4.  Incomplete- when the conjoined digits are partially fused by skin, and goes only up to the first joint.
  5.  Fenestrated- when the digit is mostly joined by skin but a gap in the middle exists.
  6.  Polysyndactyly- when there is an extra digit webbed to an adjacent digit.

    Seattle Children’s Hospital notes that in babies with amniotic band syndrome, the toes divide but join again after healing from an injury. Webbed toes are normally diagnosed at birth so early correction is possible. However, those with webbed toes cannot be said to be physically disadvantaged. Much like other people, they can perform normal functions with ease like walking. It’s more an aesthetic condition that some people may find inconvenient for proper social function so they choose to have it corrected.
    Depending on the type of webbing, surgery is the simplest course of treatment. Physical exam is usually conducted after first consulting with a physician. In children, questions will be asked like:

  • “Which fingers and toes are involved?”
  • “Have any other family member had this problem?”
  • “What other symptoms or abnormalities are present?”

    Webbing in infants may be coupled with other symptoms that may be an indication of other syndromes. It is important to diagnose the condition first based on family medical history and physical exam.  In some cases, some other tests may be necessary like chromosome studies, lab tests to check for certain enzymes, and X-ray. X-rays are always taken to identify the type of syndactylyl, more specifically to look at which bone of the toes are involved.  

    Surgical correction of webbed toes can be done as early as 6 months  of age if early diagnosis is done. The risk of anesthesia are low at that age.

    However, some people tend to wait until later to have webbed toes corrected. Because it is not physically limiting, correction of syndactyly often happens only after some symptoms become too uncomfortable. Like when both digits start to “hammer” because of being stuck together.

    The typical approach to correct webbed toes would be to separate the digits evenly in a form of a Z. To fill in the gap between the toes and a skin graft can be used to cover the areas. Only two digits are separated at a time, and the procedure only lasts 2-4 hours. Depending on the severity if the deformity , multiple surgeries may be needed to fully separate a set of digits.

    Surgery can help give you normal-looking toes. However, the surgery can cause scarring or darkening of the skin graft that may cause a self-esteem relapse, or an entirely different cosmetic problem. The creation of a perfectly normal nail may also be a challenge.
Physical therapy also helps after surgery to prevent scarring and tissue shortening.  Physical therapy also helps with stiffness, improving range of motion, and swelling.

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Guest Monday, 23 October 2017

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