Syndactyly – fused (conjoined) toes

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Syndactyly (the so-called webbing between toes) is an anatomical and congenital malformation affecting toes, whereby some of the toes are fused together. The photo below shows the fusion of two toes (most commonly between the second and third toes), which can either be due to fused skin (simple syndactyly) or also fused bones (complex syndactyly). Depending on the length of the adhesion, it is also possible to differentiate between complete (where toes are completely joined together) and incomplete syndactyly. Syndactyly can also occur on fingers.

erdogan
Adem Erdogan

Causes

This malformation most commonly occurs in utero between the fifth and seventh developmental weeks, and is often caused by entrapment of limbs in fibrous amniotic bands (the so-called amniotic band syndrome).

The congenital defect can also be a sign or one of the symptoms of a genetic disorder – such as the Smith Lemli Opitz syndrome – and can also accompany certain heart conditions, kidney anomalies, unusual head shapes, liver changes etc.

The frequency of syndactyly is estimated at 1:2,000-2,500 births. Based on this, approximately 32,000-40,000 people in Germany are affected by syndactyly(!).

syndaktylie
Patient A before surgery

Syndactyly of the hand is treated by surgery in the first two years of life, because in the child‘s further mental development his or her cognitive and comprehension skills can be negatively affected. On the other hand, syndactyly of the foot remains unrelated to cognitive development. Moreover, foot syndactyly is only seldom connected with dysfunctions.

Despite this, many patients suffer from this deformation, which is rarely noticed by other people. And the question is: Why?

Similarly, as with other physical deformations, patients affected by syndactyly mention suffering from a disruptive aesthetic defect. Patients also suffer from a psychological burden.

The psychological burden can manifest itself in the following ways:

Avoiding others
Afflicted patients are embarrassed to show their bare feet in public and permanently – even in summer – wear closed shoes. Thereby, they miss out on activities that increase their quality of life, such as walking barefoot on the beach, swimming etc.

Lack of self-confidence
Often the feeling of mutilation is mentioned. When patients are asked what their biggest wish is, the answer is often: “I just want to look normal”. That means that those people do not consider their foot or themselves as normal. The problem that they have with their foot is often reflected in their personality. That leads to another issue: stigma.

Stigma
A large number of patients who come to my practice have a feeling that they do not belong to the rest of the population and are stigmatized. This feeling leads to the above mentioned lack of self-confidence.

What to do?

How to treat patients who suffer from this condition?

First of all it is essential to realize that most patients do not speak about this difficult topic, because they are simply embarrassed. Those who make the decision to speak to people around them (or their doctors), usually receive the following types of answers: “it isn’t so bad”, “no one can see it” or “you have to come to terms with it”.

From my perspective, I would like to say the following:

  1. It is a fact that patients feel that it is ugly and everyone is staring at their feet, as already mentioned above. In my opinion the recommendations are wrong, although perhaps well-meant, because they don’t resolve anything for the patient and also leave him feeling misunderstood. Do we want to leave these people suffering all alone or do we want to take them seriously and offer them a helping hand in this difficult situation.
  2. In modern plastic foot surgery there are successful surgical methods which can resolve this issue permanently and thereby release the patient from his suffering for good. Provided the execution of the surgery and the choice of method are correct, results are, in cases with uncomplicated healing, excellent.
syndaktylie1
Patient B after surgery

Surgery methods:

De-syndactyly without a skin transplant
This method involves special incisions to separate the skin fusion and stitch it together within the newly created space between the toes. The potential scars are hidden, because they are placed between the toes.

De-syndactyly with a skin transplant
If the skin fusion between the conjoined toes isn’t simple to transfer, the above mentioned method cannot be used and a skin transplant is necessary. The necessary skin graft is harvested from the groin or ankle areas.
Healing in specially designed shoes can take 2-3 weeks. Post-surgery, full or partial movement may be permitted, or walking may be aided by two crutches. The surgeon will determine this individually depending on each case.

Anatomy and surgery anomalies:
Important blood vessels and nerves run between the toes and nourish them. Therefore they must not be affected during the procedure. It is essential for the surgeon to proceed using microsurgical methods and the aid of surgical loupes. It is also important for the surgeon to be highly experienced.

Conclusion:
Plastic surgery separation of syndactyly is a highly effective method, which not only removes the aesthetically unattractive issue, but also permanently relieves patients suffering from psychological damage and brings them the feeling of natural and normal feet.

Adem Erdogan M.D.
General surgeon
Certified foot surgeon (GFFC)
Aesthetic foot surgeon
www.adem-erdogan.de

Updated: 2015-10-23

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