Malformations of the first ray of the foot in children: diagnosis, clinical picture, treatment

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Abstract


Malformations of the first ray of the foot vary widely and are divided into simple and complex. Complex malformations include abnormality of development of the first metatarsal or the main phalanx and refer to atypical adducted foot deformity. They are also characterized by varus location of the first ray of varying severity. The cause of deformation is a damage of longitudinal epiphyseal growth plate area of the first metatarsal - “longitudinal epiphyseal bracket” or the so-called delta phalanx. Over the past five years, we treated 37 patients (53 feet) aged from 6 months to 17 years old with developmental disabilities of the first ray of the foot. The spectrum of pathology is very diverse. In the majority of cases surgical treatment was multi-staged. It was revealed that the removal of deformity at the first stage of treatment should be complete, with maximum use of the bone to restore the length and shape of the affected bone. In treating combined deformities the good effect is guaranteed only with the removal of all the elements, including excision of the fibrous bridle along the inner surface of the first ray.

Mikhail Pavlovich Konyukhov

The Turner Institute for Children’s Orthopedics, Saint-Petersburg

Author for correspondence.
Email: Klychkova@yandex.ru

Russian Federation MD, PhD, professor, honored doctor of the Russian Federation, chief research associate of the department of foot pathology, neuroorthopedics and systemic diseases. The Turner Scientific and Research Institute for Children’s Orthopedics.

Irina Yurievna Klychkova

The Turner Institute for Children’s Orthopedics, Saint-Petersburg

Email: Klychkova@yandex.ru

Russian Federation MD, PhD, professor, chief of the department of foot pathology, neuroorthopedics and systemic diseases. The Turner Scientific and Research Institute for Children’s Orthopedics

Nadezhda Aleksandrovna Kovalenko-Klychkova

The Turner Institute for Children’s Orthopedics, Saint-Petersburg

Email: Klychkova@yandex.ru

Russian Federation MD, orthopedic surgeon of the department of foot pathology, neuroorthopedics and systemic diseases. The Turner Scientific and Research Institute for Children’s Orthopedics

Igor Evgenievich Nikityuk

The Turner Institute for Children’s Orthopedics, Saint-Petersburg

Email: femtotech@mail.ru

Russian Federation MD, PhD, leading research associate of the laboratory of physiological and biomechanical research. The Turner Scientific and Research Institute for Children’s Orthopedics

  1. Wood VE, Rubinstein J. Duplicated longitudinal bracketed epiphysis ‘‘kissing delta phalanx’’ in Rubinstein-Taybi syndrome. J Pediatr Orthop. 1999;19(5):603-606.
  2. Pol R. Brachydaklyie-Klinodaktylie-Hyperphalangie und ihre Grundlogen. Virchows Arch Anat Physiol. 1921;229:388-530.
  3. Jones GB. Delta Phalanx. J Bone Joint Surg Br. 1964; 46:226-228.
  4. Shea KG, Mubarak SJ, Alamin T. Preossified longitudinal epiphyseal bracket of the foot: treatment by partial bracket excision before ossification. J Pediatr Orthop. 2001;21(3):360-365.
  5. Wood VE, Flatt AE. Congenital triangular bones in the hand. J Hand Surg [Am]. 1977;2(3):179-193.
  6. Al-Qattan MM, Abdulkareem IA, Haidan YA, Balwi MA. A novel mutation in the SHH long-range regulator (ZRS) is associated with preaxialpolydactyly, triphalangeal thumb, and severe radial ray deficiency. American Journal of Medical Genetics Part A. 2012;158-A(10):2610-2615.
  7. Schreck MA. Pediatric longitudinal epiphyseal bracket: Review and case presentation. J Foot Ankle Surg. 2006;45(5):342-345.
  8. Ганькин И. А. Хирургическое лечение детей с полидактилией стопы: дис. … канд. мед. наук. – СПб., 2007. - 153 с. [Gan’kin IA. Khirurgicheskoe lechenie detei s polidaktiliei stopy. [dissertation] Saint-Petersburg, 2007. 153 p. (In Russ).]
  9. De Visschere P, Seynaeve P. Polydactyly of the foot. JBR-BTR. 2008;91:96-97.
  10. Akercan F, Zeybek B, Karadadas N. A fetus with pre-and post-axial polydactyly. Ege Journal of Medicine. 2012;51(2):117-119.
  11. Radulescu A, David V, Puiu M. Polydactyly of the hand and foot case report. Jurnalul pediatrului. 2006; 9:33-34.
  12. Talamillo A, Bastida MF, Fernandez-Teran, et al. The developing limb and the control of the number of digits. Clin Genet. 2005;67(2):143-153.
  13. Ганькин И.А., Конюхов М.П., Клычкова И.Ю. К вопросу о лечении полидактилии стопы у детей. Мат. Рос. науч. конф. «Актуальные вопросы детской травматологии и ортопедии». – Самара: Офорт, 2006. – Т. 2. – С. 883. [Gan’kin IA, Konyukhov MP, Klychkova IYu. K voprosu o lechenii polidaktilii stopy u detei. Mat. Ros. nauch. konf. «Aktual’nye voprosy detskoi travmatologii i ortopedii». Samara: Ofort, 2006;2:883. (In Russ).]
  14. Turra S, Gigante C, Bisinella G. Polydactyly of the foot. J Pediatr Orthop B. 2007;16(3):216-220.
  15. Ahn CP, Lachman RS, Cox VA, et al. Brachydactylic Multiple Delta Phalanges Plus Syndrome. American Journal of Medical Genetics. Clinical Report. 2005; 138A:41-44.
  16. Belthur MV, Linton JL, Barnes DA. The spectrum of preaxialpolydactyly of the foot. Pediatric Orthopedic Service, Shriners Hospitals for Children, Houston, TX 77030, USA. Journal of pediatric orthopedics. 2011;31(4):435-447.
  17. Положительное решение о выдаче Патента РФ на изобретение от 14.04.2015 г. по заявке на изобретение № 2014123100/14 (037599). Коваленко-Клычкова Н.А., Конюхов М.П., Клычкова И.Ю. Способ хирургического лечения сложной формы полного удвоения первого луча стопы у детей. [Polozhitel’noe reshenie o vydache Patenta RUS na izobretenie ot 14.04.2015 po zayavke na izobretenie № 2014123100/14 (037599). Kovalenko-Klychkova NA, Konyukhov MP, Klychkova IYu. Sposob khirurgicheskogo lecheniya slozhnoi formy polnogo udvoeniya pervogo lucha stopy u detei. (In Russ).].
  18. Патент РФ на изобретение № 2509539 / 20.03.2014. Бюл. № 8. Клычкова И.Ю., Кенис В.М., Коваленко-Клычкова Н.А. Способ лечения вальгусной деформации первого пальца стопы. [Patent RUS № 2509539 / 20.03.2014. Byul. No 8. Klychkova IY, Kenis VM, Kovalenko-Klychkova NA. Sposob lecheniya val’gusnoi deformatsii pervogo pal’tsa stopy. (In Russ).].

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Copyright (c) 2015 Konyukhov M.P., Klychkova I.Y., Kovalenko-Klychkova N.A., Nikityuk I.E.

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