I had a very nice young lady come in with a complaint of bunion pain.

Webbed Toes

The interesting part of this case though, is not the bunion but a congenital abnormality she had.  She had webbing of her second and third toe with duplication of parts of the second toe.  What does this mean?  I think the pictures will explain it much better than words, see below: (click any picture to enlarge)

Above, you can see the bunion and the congenital abnormality.  There are two nails on the second digit and webbing of the skin between the second and third digit.  When you see two separate nails you can assume there is duplication of the distal bones as well because the nails are attached to the distal phalanx bones.

In the above x-ray you can see the normal bones of the third toe with three bones, the proximal phalanx, middle phalanx and distal phalanx.  You can see the bunion.  You can see the two distal phalanx bones and the middle phalanx have all fused into one large bone of the second digit.

Having extra toes (or fingers) is called polydactyl.  It is a congenital anomaly and can be hereditary (runs in families) but not always.  Treatment depends on the presentation and is usually optional.  If there are concerns from the parents of future disability or shoe fitting problems surgery is often performed as an infant.  Surgery also depends on which toe is duplicated.  In the above patient, surgery would rarely be performed due to difficulties making the toes look normal.  The nails are virtually impossible to combine.  I’ve done surgery to remove the webbing of the toes using skin flaps and skin grafts.  Surgery is much more often performed when there is duplication of the first or fifth digit which tend to make fitting shoes difficult and have an excellent cosmetic prognosis.