Does your child have syndactyly? Here’s what you need to know about fused fingers or toes
Syndactyly is one of the most common abnormalities of the extremities, where two or more fingers or toes are fused together (also known as “webbing”). This condition can be challenging for children and their families, but with proper treatment, children with syndactyly can thrive.
In this post, board-certified plastic surgeon Dr. Sharline Aboutanos explains what syndactyly is, the treatment options, and what families need to know to navigate this condition.
Understanding syndactyly
Syndactyly is a congenital condition that occurs in approximately one in every 2,000 births and may affect one or both hands or feet—about half of the cases involve both left and right side extremities.
Syndactyly varies in severity; it is not typically painful for the child as it is a condition they have had since before birth. However, in some cases, fused fingers or toes may cause discomfort or make activities, such as grasping objects or walking, more difficult.
Causes of syndactyly
Syndactyly is caused by a genetic mutation and occurs during fetal development, usually between the sixth to eighth week of gestation. A familial condition, meaning it is passed on through family genes, about 10 to 40 percent of children with syndactyly inherit the condition from a parent—syndactyly may skip a generation.
Genetic syndromes such as Poland Syndrome, Apert Syndrome, Carpenter Syndrome, and Constriction Ring Syndrome are commonly associated with syndactyly occurrences; syndactyly may also occur spontaneously.
Types of syndactyly
There are two types of syndactyly: simple and complex. Simple syndactyly occurs when only the skin is fused, while complex syndactyly occurs when bones and other tissues are also connected.
Syndactyly can also be categorized as either complete or incomplete; complete syndactyly occurs when the entire length of the digits, from the base to the nail bed, are fused together. Incomplete syndactyly occurs when only a portion of the digits are fused.
Diagnosing syndactyly
Syndactyly is usually diagnosed at birth, as the abnormally shaped digits are typically visible to the naked eye; it can also occasionally be detected during a prenatal ultrasound. X-rays are later used to assess the underlying structure of affected digits to determine the appropriate course of treatment. The child’s hands, arms, shoulders, and chest are also evaluated to check for any additional abnormalities that can be associated with syndactyly.
Photo of little boy with syndactyly in the toes
Syndactyly treatment options
There are both non-surgical and surgical treatment options for fused fingers and toes. Non-surgical treatments may be considered in mild cases of syndactyly when surgery is not deemed necessary and include stretching and splinting, as well as physical therapy to improve flexibility and strength during normal activities.
Surgery is usually recommended for moderate to severe cases of fusion and webbing. This type of operation is usually performed when the child is at least three months old and is recommended before age two.
The timing of surgery is particularly pressing when the thumb or pinky finger (otherwise known as border fingers) are affected, as they have considerably different lengths than their neighboring digits. Correcting syndactyly in infancy enables all affected digits to develop in line with their normal body growth so proper motor control can be developed despite the congenital disorder. Early treatment will also help in achieving an optimal aesthetic appearance.
Syndactyly release procedure
A plastic surgeon will begin the procedure by carefully splitting the skin between the combined digits. From here, the surgery plan will depend on the severity of the fusion and whether or not any bones are affected. If needed, a portion of skin from the lower abdomen may be grafted onto the newly separated digits. Surgery time is usually between 1-2 hours.
What is syndactyly release recovery like?
Recovery after syndactyly release surgery may be challenging, but it largely depends on the surgery’s extent and the child’s age. In general, younger children tend to have an easier recovery than older children or adults. Whatever your child’s age, it will be critical for all parents and caregivers to support the child in following all recovery rules.
Your child’s care team will provide you with postoperative care instructions, including how to care for incisions and avoid straining areas that were operated on. Your child will need to wear splints or bandages for one to two weeks to keep treated extremities still and protect healing skin. Pain medication may be prescribed to manage discomfort. After the initial healing phase, your child may then progress to wearing splints for a few weeks, to continue keeping digits properly aligned. Regular follow-up appointments with the team will be scheduled to monitor healing and address any questions or concerns you may have.
After the initial healing phase, physical therapy to reduce scarring, manage stiffness and swelling, and improve functionality will begin. Parents should work closely with the physical therapist and encourage their child to follow all their recommendations to ensure the best possible functional outcome.
With proper care and support, most children can expect to make a full recovery after syndactyly surgery,
gain near-optimal functionality, and see pleasing aesthetic results.
Is surgery considered a permanent fix for syndactyly?
Syndactyly surgery is typically considered a permanent fix for fused fingers or toes; however, surgery may not always result in a completely normal appearance or function, especially in cases of more severe syndactyly.
Sometimes, a child may need additional surgeries or therapies as they develop. As a child grows, “web creep” may occur if scar tissue grows between the digits, making it appear as though syndactyly is coming back. Following all postoperative care instructions limits this potential complication; additional treatment can help address the webbing if needed. Your child’s care team will follow their growth and development post-surgery and develop a plan of care that meets their unique needs.
Will my insurance cover syndactyly treatment?
Most insurance plans will cover the cost of syndactyly surgery if deemed medically necessary—the exact coverage and out-of-pocket expenses will depend on your individual insurance plan and the specific surgery details. It’s always a good idea to review your insurance policy and contact your insurance company directly to understand your specific coverage and note any potential limitations or exclusions.
About female plastic and reconstructive surgeon Dr. Sharline Aboutanos
As both a mother and a surgeon with years of experience in reconstructive pediatric surgery, Dr. Sharline Aboutanos deeply empathizes with parents seeking ways to optimize physical functionality, achieve aesthetically pleasing results, and otherwise support a happy, fulfilling life for their child. Dr. Aboutanos invites families in the Richmond, VA, and surrounding areas to call (804) 355-3410 or contact her online to schedule a consultation. Dr. Aboutanos and her expert medical team would be pleased to meet with your family and help you take the next steps in finding the best treatment options for your child.