Surgical Options for a One-Year-Old's Congenital Toe Fusion

Toe issues in a one-year-old girl?

Hello, doctor.
My little niece was born with her right foot's little toe fused with the sixth toe, completely merged without any separation.
Over the past year, I've observed that the merged fifth and sixth toes are growing longer, while the fourth toe seems to be getting smaller.
I would like to know how difficult the surgery would be if we decide to proceed, and what the risks are for a child.
Additionally, I noticed that your specialty is endoscopic surgery for axillary hyperhidrosis.
My sister-in-law has undergone two excision surgeries, but the odor remains very strong.
In this case, would another surgery be necessary, or is surgery ineffective? Thank you for your help.

evelyn, 30~39 year old female. Ask Date: 2008/09/18

Dr. Lu Daokuan reply Plastic Surgery

Polydactyly surgery is not dangerous, especially in areas that are not weight-bearing.
If surgery is not performed, it may crowd the growth space of the fourth toe.
After two curettage procedures, theoretically, the apocrine glands in the armpit should be mostly cleared.
However, the areola may still have an odor, which could potentially be addressed through dietary changes and the use of topical ointments.

Reply Date: 2008/09/18

More Info

When considering surgical options for a one-year-old with congenital toe fusion, also known as syndactyly, it's essential to understand both the condition and the implications of surgery. Congenital toe fusion occurs when two or more toes are fused together, which can affect the function and appearance of the foot. In your niece's case, the fusion of the fifth and sixth toes may lead to complications such as difficulty in wearing shoes, balance issues, and potential discomfort as she grows.

Surgical Considerations
1. Timing of Surgery: Generally, surgery for syndactyly is recommended when the child is between 1 to 3 years old. Performing the surgery at a younger age can help prevent complications and promote normal development of the foot. In your niece's case, being one year old is within the appropriate age range for surgical intervention.

2. Surgical Procedure: The surgery typically involves separating the fused toes and reconstructing the skin and soft tissue to ensure proper healing and function. The complexity of the procedure can vary based on the extent of the fusion and the specific anatomical considerations. In many cases, the surgery is performed under general anesthesia, and the recovery period can vary from a few weeks to a couple of months, depending on the individual child's healing process.

3. Risks and Complications: As with any surgical procedure, there are risks involved. These can include infection, bleeding, and complications related to anesthesia. However, when performed by an experienced pediatric orthopedic surgeon, the risks are generally low. The long-term success rate for syndactyly surgery is high, with many children achieving good functional and cosmetic outcomes.

4. Postoperative Care: After surgery, the child will likely need to wear a splint or cast to protect the area as it heals. Pain management will be essential, and parents should monitor for any signs of infection or complications. Physical therapy may also be recommended to help the child regain full function of the toes.

Conclusion
In summary, surgical intervention for your niece's congenital toe fusion is a viable option and can significantly improve her quality of life. It is crucial to consult with a pediatric orthopedic specialist who can assess her specific condition and provide tailored recommendations. The surgeon will discuss the potential risks, benefits, and expected outcomes of the procedure, ensuring that you make an informed decision.

Additional Note on Hyperhidrosis
Regarding your sister-in-law's issue with excessive sweating (hyperhidrosis), if she has undergone two surgical procedures without satisfactory results, it may be worth exploring other treatment options. Surgical interventions for hyperhidrosis can vary, and sometimes, additional procedures or alternative treatments such as Botox injections, iontophoresis, or medications may be more effective. Consulting with a dermatologist or a specialist in hyperhidrosis can provide more insight into the best course of action for her situation.

In both cases, the importance of consulting with qualified medical professionals cannot be overstated. They can provide the most accurate assessments and recommendations based on the latest medical knowledge and techniques.

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