How is macrodactyly diagnosed?

The presentation of macrodactyly varies with each patient.

• If the child has static macrodactyly, the affected fingers or toes will be about one and half times the length and width of the normal adjoining fingers.
• If the child has progressive macrodactyly, then the involved digits may be huge. This can lead to sever deformities of the foot or hand and can lead to functional impairment also making the child not able to use the hand or foot well.

The following features are seen in the hand or the foot-

• The hand/foot may show overgrowth with excessive formation of fat.
• Affected digits may be stiff and curved
• The fingers often deviate away from each other
• Overgrowth in palm and forearm or sole area of foot is often seen.
• Excessive fatty tissue commonly seen along the median nerve in the hand

Serial X-rays demonstrate the extent of deformity

MRI is sometimes done to demonstrate other abnormalities present in the overgrown finger or toe.

How is the surgery done for Macrodactyly for a child at Kayakriti?

The main goal of the surgery is to maximize the function of the finger and a better cosmetic match with the other fingers or toes.

In mild cases, only careful observation is advised with regular follow ups.

Inseverelydeformed fingers or toes or with progressive macrodactyly, surgery is advised which will be done in stages. The surgery cannot be done in single stage in Macrodactyly as all the components (nerve, vessel, bone, skin and fat) are larger in the digit.

• Epiphysiodesis of the bone - In first stage, epiphysiodesis is done to arrest growth of the digit along with the excision or debulking of the involved digital nerve.
• Debulking procedure for soft tissue - Debulking is usually done to decrease the width of the finger or toe. It is usually done in multiple stages and the interval should be at least 3 months between sessions. Excision of the involved digital nerve may slow down the overgrowth as believed (TSUGE).
• Shortening procedure for the bone - If the growth arrest is not satisfactory or if the digit has much overgrown, then corrective osteotomy (cutting of bone) of the middle bone (phalanx) and the distalbone (phalanx) with removal of bone and fixation with k-wire is done.
• Arthrodesis of the joints of the involved fingers or toescan also be attempted.
• Amputation of the finger or toe has been tried in overgrown digits with stiffness and limited function or those that interfere with the function of the other normal digits.