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Macrodactyly
Macrodactyly is a congenital deformity characterized by
increased size of the digits including the bones, nails, nerves, skin and
subcutaneous fat. The hands are more commonly affected than the feet. The origin
of the disorder is unknown.
Case Presentation
A 38-year-old female with history of Macrodactyly presented to the office with
pain in the 2nd MPJ of the left foot. Over the years the patient had become
quite proficient at obtaining accommodative shoe gear. She was not particularly
concerned about cosmetics but certainly wanted an improved appearance.
PMH – unremarkable
Meds - None
N.K.A.
Surgical HX - Symes amputation 2nd toe. (To allow the foot to fit into standard
shoe gear)
Social – does not smoke, does not drink alcohol
Conservative measures consisting of cortisone injections had failed to render
the patient asymptomatic.
X-rays revealed hyperostosis’ along 2nd and 3rd MPJ. The proximal and middle
phalanges were broader than normal.
Surgical Procedures
1 – Arthroplasty with debulking 2nd and 3rd toes left with .045 K-wire.
2 – Arthroplasty with debulking 2nd and 3rd MPJ’s left.
3 – Skin plasty of 2nd toe.
4 – Syndactyly 2nd and 3rd toes left.
Intraoperatively we encountered lipomatous tissue, which was excised
The cartilaginous surface of the 2nd MPJ was preserved. An
ostectomy of the surrounding bone was performed. The girth of the head and base
of the Phalanges was reduced. Once hyperostotic bone was removed the toes were
easily brought together and a syndactly was performed. The patient may
ultimately require additional revisional surgery.
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Jay Lieberman, DPM
Editor - PRESENT
Director of
Podiatric Medical Education
Northwest Medical Center
Margate,
Florida
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