KidsMD Health Topics

Macrodactyly

  • Macrodactyly is an uncommon condition in which a baby’s toes or fingers are abnormally large due to the overgrowth of the underlying bone and soft tissue. The condition is congenital, meaning babies are born with it.

    • Macrodactyly happens more often to hands than feet.
    • Most of the time, only one hand or one foot is affected, but usually more than one digit on that hand or foot is involved.
    • Macrodactyly may coexist with syndactyly, a condition in which two fingers or toes are fused together.
    • Although it is a benign condition, macrodactyly is deforming and can look cosmetically displeasing to you and your child.

    Surgery, usually involving multiple procedures, can help the problem.

    Boston Children's Hospital's approach

    Combining training in adult and pediatric orthopedics, hand surgery, plastic surgery and microsurgery allows our surgeons to provide a comprehensive level of care unmatched in most other hospital settings.

    Hand and Orthopedic Upper Extremity Program

    The Hand and Orthopedic Upper Extremity Program provides comprehensive care involving occupational and physical therapy, splinting, casting and reconstructive surgeries for infants, children and adolescents with complex congenital, neuromuscular, sports-related oncologic and traumatic upper limb conditions.

    Hand and Reconstructive Microsurgery Program

    The specialists in the Hand and Reconstructive Microsurgery Program at Boston Children's are experts in the management of congenital and acquired hand deformities. We recognize the social elements involved in pediatric hand surgery, so an essential part of these operations has been making the child's hand as symmetrical as possible with his unaffected hand. 

  • What causes macrodactyly?

    Researchers do not know why macrodactyly occurs, but they believe that it doesn’t result from anything the mother did (or didn’t do) during her pregnancy. Although babies are born with the condition, macrodactyly is not inherited.

    It can occur in association with other conditions and syndromes, including:

    What are the symptoms of macrodactyly?

    One or more of your child’s fingers or toes will be much larger than his other fingers or toes. Macrodactyly is more commonly considered static, which means that the enlarged finger or toe grows at the same rate as the normal finger or toe on your child’s hand.

    However, it can also be progressive, with the affected digits growing faster than the rest of the hand.

    • In the static type, your child’s involved digits will generally be about one-and-a-half times the length and width of the normal digits.
    • If the condition is progressive, the involved digit or digits can become enormous.
  • How is macrodactyly diagnosed?

    • Most of the time, a child’s macrodactyly is obvious soon after birth.
    • Occasionally, however, the progressive type may not be detected until later in infancy, when continued enlargement occurs.

    Your child’s doctor will perform the following diagnostic tests to determine which underlying layers of tissue are enlarged:

    X-rays - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs on film.

    Magnetic Resonance Imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.

  • How is macrodactyly treated?

    Your child's physician will discuss specific treatment options with you, and treatment depends on whether the condition occurs in the hand or the foot.

    Your doctor's goal will be to give your child optimal function of the affected area.

    • A hand can still be quite functional with a finger or two larger than the rest.
    • Even a slightly enlarged toe may make wearing shoes impossible.

    In mild cases, treatment for macrodactyly may involve observation or, in the case of an enlarged foot, shoe modification alone.

    Surgery

    Most of the time, however, surgery is required to correct macrodactyly. The surgery is complex because it involves multiple layers of tissue. It may take several surgical procedures to achieve the desired result.

    Size-altering surgery will involve extensive observation and planning, because doctors will want to plot the rate of growth of your child's normal digits versus the enlarged digits.

    Your child's doctor may recommend some combination of the following surgical procedures:

    Soft tissue debulking

    To help correct width, this procedure involves the surgical removal of the thickened layers of skin and fat and the replacement of skin with skin grafts harvested from healthy skin in a nearby area. This procedure is usually performed in several stages around three months apart.

    It's more often used to treat the milder forms of macrodactyly or as a part of the treatment of the more progressive forms.

    Shortening procedures

    To help correct length, shortening procedures usually involve either surgical removal of one of the phalanges of the finger or toe, or removal of a metacarpal (hand bone) or metatarsal (foot bone).

    Ray resection

    Surgical removal of the entire digit or digits is sometimes necessary, particularly when the condition is progressive. It is also an option if there is excessive widening of the forefoot, where the digital shortening and debulking procedures may not be effective.

    What is the long-term outlook for my child?

    The long-term outlook for a child treated for macrodactyly varies from child to child, depending on how severe his problem is.

    You and your child can expect an overall improvement in appearance and function. However, it's rare that a child's affected digits look and move perfectly.

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