Syndactyly of the toes (attached toes) is the fusion of the soft tissue of one or more toes that are next to each other. Learn more about syndactyly of the toes and how it is treated.
Key points
Syndactyly is a congenital condition where the soft tissue of two or more toes is fused together. This can occur in both the hands and feet and is often noticed at birth.
Having syndactyly does not delay a child from reaching motor milestones and does not usually cause any symptoms.
In most cases, syndactyly does not require surgery.
Introduction
What is syndactyly of the toes?
Syndactyly of the toes is the fusion, or joining together, of two or more toes that are next to each other. It is a congenital condition that is present at birth and can sometimes be associated with other conditions as a part of a genetic syndrome.
Syndactyly of the toes can range from simple cases where there is a webbed appearance between the toes to more complex cases where bones and other tissues are fused. Complex cases can also refer to multiple toes being fused (polysyndactyly). Polysyndactyly is often related to other conditions as part of a genetic syndrome.
In most cases, simple syndactyly does not affect the function of the toes or cause pain. Webbing of the 2nd and 3rd toes is extremely common and only rarely requires surgery. When the 2nd and 3rd toes are webbed, they typically grow at the same rate and achieve equal length. They perform identical tasks together. Children with syndactyly of their toes typically meet motor milestones, such as walking and running.
Most babies and children with syndactyly of the toes do not need surgery. Complex syndactyly rarely causes pain or affects the function of the toes. However, in severe cases, it may impact a child's ability to walk or wear shoes comfortably. Surgery is only recommended if there is an associated deformity of the toes that prevents comfortable shoe wear or causes skin issues and/or nail issues.
Surgery to separate the toes leads to visible scars that are often more sensitive and appear worse than the webbing itself, and there is always a risk of the syndactyly reappearing (with web creep over time).
Diagnosis
How is syndactyly of the toes diagnosed?
A health-care provider will ask about symptoms of pain and if the function of the toes is affected versus cosmetic concerns. You will also be asked about any family history of syndactyly or other congenital conditions.
A health-care provider will complete a physical exam of the affected toes. For simple syndactyly, no X-rays are needed. For complex syndactyly, X-rays may be considered to determine the extent of the fusion or if there are other concerns regarding pain or ability to wear shoes comfortably.
Treatment
How is syndactyly of the toes treated?
Most cases of syndactyly of the toes do not require treatment. Simple syndactyly, where there is a webbed appearance between the toes does not require treatment. For complex syndactyly where bones and other tissues may be fused, initial treatment may involve wearing wider shoes.
Surgery may be considered if there is a deformity of the toes, usually of the 1st or 2nd toe, that prevents shoes from being worn comfortably or if there are skin and/or nail issues. Surgery is rarely performed on the lesser toes alone.
Risks of surgery include:
Hypersensitivity - Scars are often very sensitive after surgery and cause more discomfort or pain than the syndactyly itself
Scarring - Surgery can result in scarring, which may affect the appearance and function of the toes in a negative way that is greater than the syndactyly itself
Recurrence - there is always a risk of the syndactyly returning with web creep
At Sickkids
At SickKids
SickKids does not accept referrals for syndactyly of the lesser toes (D3-5). For syndactyly of the 1st and 2nd toes with functional concerns, a referral to Plastics can be considered.
References
References
Mosca, V. (2014). Principles and Management of Pediatric Foot and Ankle Deformities and Malformations (1st ed.). Wolters Kluwer Health
