“Webbed toes” refers to a condition in which toes are fused to each other. It is also called “syndactyly,” but the term syndactyly is commonly used to refer to both fused fingers and fused toes. Webbed toes are also known as twin toes, duck toes, turkey toes, and tiger toes.
The toes most commonly fused together are the second and the third toes. But other toes may be fused as well. In some rare incidences, multiple toes may be fused together. Both feet may have webbed toes as well. Usually, only skin and soft tissue are fused (cutaneous connection) but in rare cases, the bones may be fused as well (osseous connection).
So happy for our patient who was affected by webbed toes 2 & 3 of both feet (Syndactyly of toes) and desired cosmetic correction. Skin graft was harvested and used to cover the void left after separation. Both patient and surgeon super ecstatic about the amazing outcome.
The embryo develops into the complex human form after a miraculous and complex process in the mother’s womb. In the embryonic phase, the hands and feet develop in the form of paddles. They don’t have fingers and toes initially. Then, apoptosis (or programmed cell death) occurs and carves fingers and toes in the hands and feet. Webbed toes occur if the apoptosis, or programmed cell death, can’t take place properly between any two toes.
Causes of this phenomenon are unknown. There is a mild genetic predisposition as it affects members of the same family. Other than that, no other causative factors have yet been identified.
Most of the time, webbed toes occur as an isolated condition, but they may be a part of some other syndromes as well. The most common of these syndromes is Down’s syndrome.
The incidence of webbed toes is nearly one in every 2500 births.
Besides the visibly fused toes, there are no other signs or symptoms of this condition. The patient can walk and run properly.
The doctor will diagnose it on general examination by examining the fused toes. The doctor will perform a complete examination to rule out any associated syndromes with the webbed toes such as Down’s syndrome.
The doctor may order a few tests to see the extent of the fusion and to see if the bones are separate or fused. These tests may include an X-ray, CT or an ultrasound scan.
There is only one treatment available for webbed toes and it is the webbed toes separation surgery. This surgery is sometimes termed as de-syndactyly.
The purpose of this surgery is purely cosmetic as the webbed toes do not interfere with any function of the toes. But the patient may feel uncomfortable with the outward appearance of their feet.
This surgery can be performed in two ways.
This surgery can be carried out at any age but keep certain considerations in mind.
In most cases, this surgery is usually performed between 12 and 18 months before full development has occurred.
Syndactyly of the fingers may affect motor and cognitive development of a child. But it is different for fused toes. Syndactyly of the toes normally doesn’t have negative impact on the motor and cognitive development of the child as no physical function of the child is limited by this condition. Some surgeons and guidelines advise waiting for the child to grow up. Although it is perfectly safe to have this surgery performed in childhood as well.
Anesthesia is given to the patient by a qualified board certified anesthesiologist. Then, the skin flaps are raised in the shape of a Z. The fused tissue is then separated. If the bones are fused as well, they are separated by cutting them at this stage. The skin incisions are then closed via subcuticular sutures in a tension-free method to minimize the scar marks. In some instances, a flap of skin is also grafted to cover the wound. On average, these corrective surgeries can take anywhere from about two to five (2-5) hours depending on the complexity of the condition.
The surgery for the separation of fused toes is generally performed under general anesthesia or IV Sedation.
Tell your surgeon about any medical conditions you have. If the patient is a child, his parents should inform the doctor of their medical history.
Before performing any surgery under general or IV Sedation anesthesia, tests for anesthesia-fitness are performed. These include heart function tests, kidney function tests, and lung function tests.
A history of any allergies, drugs and alcohol use will be taken.
With any surgery, there are risks of getting complications related to the anesthesia and the actual surgical procedure.
No hospital stay is required after the surgery. The toes which were operated on are usually put into a special shoe or boot to immobilize them so that the skin gets a chance to heal. Pain medications will be given for a few days after the surgery.
The gauze bandage stays on for two weeks after the surgery. The dressings on the wound will be removed completely by 4 to 6 weeks depending on heeling status. A pad (rubber spacer) may be used for a few weeks to keep the toes separated after the dressings come off to prevent the formation of any adhesions while the skin regrows. Keep the scar moisturized and massage the scar. It will help to keep the scar soft.
Try to rest as much as possible after the surgery.
It is okay to walk a bit in a special orthopedic shoe (but only do very important tasks like going to the restroom). Whenever you take your foot down, a little swelling on it is normal. Keeping the foot elevated will resolve this swelling.
You will regain the complete function of the foot back gradually after the bandages come off. Wear a special orthopedic shoe for two to three weeks after the surgery so that the skin wounds may heal completely.
A few sessions of physiotherapy may be needed if the joints become stiff due to immobility after the surgery. This will help the joints to gain complete function back.
Your doctor will schedule some follow-up visits after your surgery to see if the wounds have healed properly and if the desired results of the surgery have been obtained. But if you feel any of the symptoms below between those follow-up visits, contact your doctor as soon as possible.
This corrective surgery for the fused and or syndactly of toes has a very high success rate. If the toenails were fused as well, the shape of the toenails may not be completely normal and often can differ form the uninvolved toes after the surgery.
Although rare, it is possible that some patients may require additional corrective surgeries after the first procedure.
It typically takes a month or so before the patient can begin to put pressure on the separated toes and 3–6 months before they fully heal from the surgery, depending upon the extent of the procedure.