Kilawa Shindo Isack, Nkya Gilbert Zacharia, Shoo Reginald R, Mrimba Peter Magembe, Temu Rogers J, Shirima Octavian A
Department of Orthopedics and Traumatology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Int J Surg Case Rep. 2024 Jun;119:109723. doi: 10.1016/j.ijscr.2024.109723. Epub 2024 Apr 30.
Megadactyly of the foot is uncommon non hereditary congenital anomalies of the extremities and poses a dilemma on treatment however multiple treatment modalities were developed but is not uniform to all patients with megadactyly. The goal of the surgical treatment is to achieve painless and function of the foot.
We report a 14 years old male presented with complaints of progressive enlargement 2nd, 3rd, 4th and 5th toes of the right foot since birth, associated with inability to wear shoes. One month prior to admission he experienced gradual onset painful forefoot and toes that was increasing in severity with time associated with inability to walk normally. He is the first born in a family of four children and his other siblings are healthy with no anomalies. On clinical evaluation, he was health with stable vitals, with enlarged 2nd, 3rd, 4th and 5th toes of the right foot with no tenderness with intact neurovascular status. On clinical and radiological evaluation he was diagnosed with congenital megadactyly of the right foot, a multidisciplinary team including orthopedic surgeons and prosthetics team agreed to do trans-metatarsal, then partial foot prosthesis fabrication. He underwent trans-metatarsal amputation of the affected foot and tissue sample was taken for histopathology. The histological findings revealed bone enlargement with increased proliferation of subcutaneous adipose tissues with increased fibrous septae together with thinning of the epidermis, features suggestive of lipomatosis. The wound site healed very well after 14 days stitches were removed and the child was scheduled for follow-up after six weeks, 12 weeks and 6 month post-surgery. On the last visit he was free from pain on his right forefoot and toes, able to wear fabricated partial foot prosthesis and shoes normally, walk with no incapacitation.
Our case report is unique due to the involvement of the multiple toes of the right foot with syndactyly at third and fourth toes and its management is challenging because there is no uniformity in its surgical treatment, in our case trans-metatarsal amputation was done and the patient progressed well after six months of follow up.
Foot megadactyly is uncommon congenital malformation, most common on the right foot. Regardless of the dilemma on treatment, the trans-metatarsal amputation and a fabricated prosthesis to our patient fulfilled the goals of painless right foot and able to wear shoes and walk normally with no impairment.
足部巨趾症是一种罕见的非遗传性先天性肢体异常，在治疗方面存在难题。尽管已开发出多种治疗方法，但并非适用于所有巨趾症患者。手术治疗的目标是实现足部无痛且具备功能。
我们报告一名14岁男性，自出生以来右脚第二、三、四和五趾逐渐增大，伴有无法穿鞋的症状。入院前一个月，他逐渐出现前足和脚趾疼痛，且疼痛程度随时间加重，同时伴有无法正常行走的情况。他是家中四个孩子中的老大，其他兄弟姐妹身体健康，无异常。临床评估显示，他身体健康，生命体征稳定，右脚第二、三、四和五趾增大，无压痛，神经血管状况良好。经临床和影像学评估，他被诊断为右脚先天性巨趾症。一个包括骨科医生和假肢团队的多学科团队同意进行经跖骨截肢，然后制作部分足部假肢。他接受了患足的经跖骨截肢手术，并采集组织样本进行组织病理学检查。组织学检查结果显示骨增大，皮下脂肪组织增殖增加，纤维间隔增多，同时表皮变薄，这些特征提示脂肪过多症。术后14天拆线，伤口愈合良好。患儿计划在术后六周、12周和六个月进行随访。在最后一次随访中，他右脚前足和脚趾无痛，能够正常穿戴制作的部分足部假肢和鞋子，行走无障碍。
我们的病例报告具有独特性，因为右脚多个脚趾受累，第三和第四趾并趾，其治疗具有挑战性，因为手术治疗尚无统一标准。在我们的病例中，进行了经跖骨截肢，患者在随访六个月后恢复良好。
足部巨趾症是一种罕见的先天性畸形，最常见于右脚。尽管治疗存在难题，但对我们的患者进行经跖骨截肢和制作假肢实现了右脚无痛、能够穿鞋且正常行走无损伤的目标。
