Joined toes rarely need treatment because they rarely cause any problems with a child’s function. If syndactyly makes your child’s toes grow at an angle that’s not normal, your child may need surgery to divide the toes.
Doctors almost always perform surgery to divide joined fingers in early childhood. The goal is to give your child hands that work well and look typical. Rarely, doctors leave two fingers joined. Your child’s doctor may recommend this if the digits work well as a unit but are not likely to work apart because they share nerves, blood vessels and tendons.
Syndactyly Treatment Options
There are many ways to do surgery for syndactyly. Your child’s surgery will be based on which digits are joined and how complex the connection is. If only two digits are joined and they are joined only by skin, the surgery will be simpler. If more digits are joined or the digits are joined at the bone, the surgery will be more complex. In any case, it is often done as day surgery.
The basic method for the surgery is to make zigzag cuts (incisions) between the digits to divide them. The zigzag shape gives the surgeon pointed flaps of skin to wrap around each digit. This method helps prevent scars that could restrict growth later.
Near the base of the digits, the surgeon cuts another flap of skin that gets folded over to make a typical web between the digits. The surgeon sews all the flaps in place.
Most children need skin grafts to cover the digits completely after they are divided. The zigzag method reduces the need for skin grafts. But sometimes the flaps are not big enough. The surgeon takes a small patch of skin, usually from the child’s forearm or their belly near their hipbone, to close up the area around the digits.
After surgery, your child will need to wear a cast. The doctor will want your child to come back for follow-up visits to make sure they are healing well. At a follow-up visit, the cast will be removed, and an occupational therapist will fit your child with a splint. This helps prevent scarring and shortening of tissue (contractures). Some children who have extensive surgery, cutting through many tissues, may have occupational therapy to help with swelling, scarring and stiffness.
The timing of surgery varies. Your child’s team will make a plan based on your child’s needs.
In general, surgery needs to be done earlier for digits joined in a more complex way. Dividing the digits early can prevent problems that might happen as your child grows. A digit that is joined to its neighbor may grow at an angle or become twisted because the digits grow at different rates.
In most cases, surgeons divide the thumb from the first finger and the ring finger from the little finger around the age of six months. If any of the middle three fingers are joined, they are usually divided after the age of 1 year.
If your child has three or more joined digits, they will need more than one surgery. The surgeon will work on only one side of a digit, not both sides, during one surgery. This reduces the risk for problems with blood flow to the digit.