SURGICAL SYNDACTYLIZATION FOR THE TREATMENT OF RECURRENT SEVERE TOE DEFORMITIES

Abstract

Syndactyly is hereditary observed in animals and humans. While the syndactyly between fingers is normally surgically released, syndactyly between toes rarely requires treatment. Considering this observation, a surgical syndactylization has been already postulated more than 50 years ago as a salvage procedure in severe recurrent toe deformities to avoid amputation. Since then, only few sporadic case reports have been published, mainly focusing on techniques rather than on outcomes. This study describes our surgical technique and the clinical results in 15 patients (13 females, mean age 58.3 years) at a mean of 32 months after surgical syndactylization for the treatment of 18 severe toe deformities (10 digitus superductus, 5 digitus varus, 3 hammer toes, 2 floppy toes, 2 floating toes). All patients suffered from recurrent deformities after failed previous surgery. We noted all complications and revisions. Clinical outcomes were assessed using subjective ratings and the American Orthopaedic Foot and Ankle Society (AOFAS) score for the lesser toes. There occurred no intra- or postoperative complications and no revision surgery was necessary. Eleven patients (73%) were very satisfied with the operative results, and four (27%) were satisfied. Preoperatively, only two patients (13%) were satisfied with the cosmetic appearance of their feet while all patients (100%) were very satisfied or satisfied at follow-up. Thirteen patients (87%) would undergo the same type of surgery again, and one patient (7%) would not. AOFAS scores significantly improved from 33.1 ± 18.4 points preoperatively to 84.0 ± 14.4 points at follow-up (p< 0.0001). The present results demonstrated that the surgical syndactylization between toes is a successful salvage procedure for the treatment of recurrent severe toe deformities. Subjective ratings regarding patient satisfaction and the cosmetic appearance were excellent and AOFAS scores significantly improved. Hence, the surgical syndactylization should be considered as an alternative treatment option instead of toe amputation.