Primary On-top Plasty for Treatment of Short-type Postaxial Polydactyly of the Foot.

Abstract

Postaxial polydactyly of the foot is typically treated with medial or lateral toe ray resection. However, simple ray resection does not always give a natural postoperative appearance, especially for short-type polydactyly. The purpose of this article was to describe our primary operation with on-top plasty for lengthening of short-type postaxial polydactyly. Four patients (mean age, 11.3 months) underwent this procedure. Ray transfer was performed at the proximal phalangeal level. Lateral distal and middle phalanges were resected and the medial ray was transferred on top of the remaining lateral proximal phalanx. Preoperative and postoperative toe lengths and complications were evaluated by comparison with the contralateral side on x-ray. All toes were lengthened by a mean of 115.1% from the tip of the distal phalanx to the bottom of the proximal phalanx relative to contralateral side. Appearances were very natural without valgus deformity and hypertrophic scar. And there was no remaining dysfunction in walking after a mean of 21.5 months follow-up. This on-top procedure is useful for improving toe lengthening and bone alignment correction with minimal functional disturbance.