Pediatric Hand and Foot Surgery

Affecting one in every 3,000 newborns, syndactyly is a condition present at birth in which the digits (fingers or toes) are webbed or joined. About half of those cases affect both the hands and the feet. Boys and Caucasians are more likely to be affected.

Surgery is the only treatment, and more than one surgery may be necessary to completely correct the deformity. Most patients have a completely restored appearance and function after syndactyly surgery.

Polydactyly refers to an extra finger or toe. The additional digit(s) may vary from a miniature, raised bump to a whole and completely functional finger or toe. It is the presence of extra digits at birth on either a hand or foot, or sometimes both. Like syndactyly, polydactyly is more common in boys and Caucasians. It occurs in about one in 1,000 newborns.

Duplicate thumb is a form of polydactyly. Thumb duplication, or pre-axial polydactyly, means that there are two thumbs on one hand. Thumb duplicates are more common in Asians, Caucasians and Native Americans.

Surgery is the only treatment and should be performed before the child’s first birthday for the best outcome. Most patients have a completely restored appearance and function after polydactyly surgery.

A side curvature of a finger or toe is called clinodactyly. It typically affects the smaller digits (pinky finger or toe). Most people do not need treatment for clinodactyly, but patients with severely curved fingers or toes benefit from surgical correction of clinodactyly.

Brachydactyly is a congenital condition that causes shortness of the bones in the hand and/or feet. This causes the fingers or toes to be disproportionately smaller. It may occur as a singular malformation or be associated with other conditions such as syndactyly. 

Surgery is used to treat brachydactyly when function of the hand is affected, or it can be used electively for cosmetic reasons.

A rare condition only affecting about 1% of the population, camptodactyly is a condition in which the fifth finger is permanently bent and unable to extend. It may occur as a result of a muscle or bone deformity, tight skin or contracted ligaments or tendons. Camplodactyly is not confined only to the pinky finger, as this condition can can affect any digit. 

Children can be born with camptodactyly or it may develop later in life. This condition is often hereditary. Treatment for camptodactyly is typically centered around hand therapy to try to straighten the finger. Surgery may be used to help release or move structures such as tendons that may be interfering with joint extension.

An often-painful condition, trigger finger or trigger thumb (stenosing tenosynovitis) causes the affected digit to lock or catch in a bent position. In children, it usually occurs from inflammation in the tendons under the protective coverage of the tendon sheath.

Trigger finger surgery is used to treat this condition. During the surgery, the tendon sheath tunnel is cut to allow for greater flexibility and to allow the tendon to extend more easily.

Amniotic band syndrome occurs during fetal development, causing congenital birth defects. It is believed that fibrous amniotic bands in the womb cause limbs, digits or other fetal parts to become trapped in strings. It may cause syndactyly, clubfoot, clubhand, cleft lip and/or palate and hemangiomas.

Because amniotic band syndrome causes many different types of hand and foot deformities, treatment will depend on the specific condition it has caused. Surgery is used to help improve function and correct cosmetic issues.

Reconstructive hand and foot surgery may be performed for broken bones that are deformed, malaligned, unstable or involve a joint. To help stabilize the area, screws, metal plates or pins may be added permanently during surgery.

Just as the name implies, crush injuries occur from compression, or crushing, of the body. It happens when a child’s hand is slammed in a car door or they get knocked to the ground by a heavy object falling, which lands on a foot.

Treatment for severe crush injuries of the hand or foot often involves surgery to eliminate pressure on muscles and nerves while correcting any disfigurement that arises from the injury. Hand or foot surgery to alleviate compartment syndrome from crush injuries is necessary to avoid amputation.

Ganglion cysts appear as bumps on the hands or feet. They are filled with a harmless fluid and often come and go, disappearing on their own. Ganglion cysts may be uncomfortable or painful, interfering with normal activity.

When they interfere with function or are painful, surgery is used to treat ganglion cysts. Some may choose to have them removed for cosmetic reasons. The cyst(s) is removed during outpatient surgery. Most of the time, a cyst will not return after surgical removal.

Hand or foot tumors, whether malignant (cancerous) or benign (non-cancerous), can occur on top of the skin or underneath it in soft tissue or bone. Ganglion cysts are a type of hand tumor and are fairly common, as are epidermal inclusion cysts and giant cell tumor of the tendon sheath in the wrist.

Lipomas and neuromas are also commonly seen and are typically benign. Surgical treatment for hand or foot tumors is used to improve symptoms caused by the tumor, which may include numbness, tingling, loss of mobility or function, mild discomfort, or pain.