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Master X was born with polydactyl with an extra hallux on both feet.
He had surgery performed in April this year (approx 15 months old) to remove the extra hallux from both feet, and the surgery went well with nil infections and minimal complications at the time
The K wire that was inserted to keep the toes straight stayed in for 7 weeks duration and was removed approximately 5 months ago.
After the K wires have removed there has been a noticeable gross deformity develop of the hallux toe on both feet with adduction of the hallux relative to the rearfoot.
This is reported to have progressed rapidly since the K-wires have been removed.
No other birth history noted, his mum does report frequent tripping and falls at this stage. Hard to decipher if it is causing him any pain.

He has had x-rays taken post surgery and all was reported to be within normal limits
The orthopaedic surgeon who operated on Master X doesn't want a review him until June 2015.

Assessment conducted today, it was hard to keep a 20 month old still enough to conduct a thorough assessment I have uploaded the photo and x-ray which demonstrates this hallux deformity
Bisections performed on X-ray bisecting the hallux and the rearfoot show that the hallux is 40 degrees is adducted from the rearfoot and this is 45 degrees on the right foot from the rearfoot and calcaneal bisections.
Assessment of the foot reveals that the hallux toe is flexible and is able to be corrected to a better position relative to the rearfoot. Dorsally along the scar tissue line there is what seems to be scar tissue in the B/1st webspace as well.

Has anyone come across a similar case scenario like this before as any help towards a treatment management plan would be greatly appreciated.
He has just started wearing footwear which has helped with the alignment of the toe, but I wasn't sure if footwear alone was enough as a management plan?
Cheers,

Susie

 

I have no surgery skill at all, but do have biological ones. We should all understand that there is nothing clever about the number five in terms of pentadactyle stuff; the fossil record exhibits at least 8, 9 10, or even 11. I refer anyone interested (which should be all of you) to Professor Neil Shubin's work starting with a book titled "your inner fish". The point is that the genes that control the number of digits are still there, but turned off. And it is only when something in the (in this case The Sonic Hedgehog) goes a bit adrift that the number comes out wrong.

But when the genetics give a situation like this, one should surely have to go back to basics: what is the correct components for this foot, which are the supernumeraries? It may not be possible to tell, but it is a serious question that deserves serious consideration. One assumes this is a thought process used in deciding which one to remove.