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Macrodactyly is a rare condition, which causes enlargement of a child’s fingers or toes. It is due to an overgrowth of a variety of different tissues including bone. It is a rare condition affecting one out of 50,000 live births. It involves the hands more than the feet and multiple fingers are usually affected. It is a benign condition but sometimes the overgrowth can be functionally debilitating and cosmetically unappealing.
The exact cause of macrotactyly is unknown. The condition is congenital which means that children are born with it. However it is not an inherited condition. It can occur in association with other abnormalities or syndromes including vascular malformations and neurofibromatosis.
Macrodactyly tends to behave in two different ways. There is something known as the static type where the child’s enlarged finger or toe grows at the same rate as the rest of the hand or foot. In the progressive type the growth is out of proportion with that of the rest of the body and the child’s affected fingers or toes can the very large and problematic.
Macrodactyly can be diagnosed at birth. It can however become more obvious as a child grows particularly in the progressive type. After a thorough history and careful examination some diagnostic tests may be required to determine the extent of the your child’s in condition including x-rays and occasionally MRI scans.
The maintenance and improvement of function are always the primary goals. Treatment is dependent on which part of your child’s body is affected, how extensive the condition is and its growth pattern. In some mild cases treatment may not be required. Initial conservative measures may be as simple as shoe modification. Surgery is required when function is affected.
There are a number of different surgical options available for the treatment of macrotactyly which may be used in combination. It is important to assess the rate of growth of your child’s affected digits/toes compare to the rest of their body. Surgical treatment is should be individualised to your child’s particular condition. Surgical manoeuvres include:
This involves the removal of enlarged areas of tissue usually along one side of a finger or toe at a time. It can be complicated by a degree of delayed healing, problematic scarring and the need for repeated procedures in the future.
Epiphysiodesis refers to a procedure in which the growth area of a finger or toe bone is purposefully removed or treated to control unwanted subsequent growth.
Sometimes debulking procedures and/or epiphyseal ablation are ineffective in halting the progression of macrotactyly. This is particularly the case in the more progressive type. If the growth is likely to be relentless and functionally debilitating surgical removal of an entire digit or digits may be required to maintain function.
This varies depending on the severity, extent and growth pattern of the condition. Significant improvements can be achieved through surgery for those who require it. Careful and regular assessment is key to ensuring the correct treatment pathway.