EXTRA FINGER: The most common form of polydactyly is a small, soft, extra finger that contains no bone. —Photos: AYANNA KINSALE
The problem with polydactylism
Most of us are born with ten fingers and ten toes; however, having an extra finger or toe is common — men, women and children are commonly seen with a little stub on their “pinky” finger. The extra finger may also be located on the thumb side of the hand, the small side of the hand or the middle of the hand and appears to be fully formed while in some cases there’s just a little stump. The digits typically are smaller and abnormally developed. What’s the medical term for having extra digits? Polydactyly — having extra fingers or toes.
At first glance, Stacy Adams appears perfectly formed in every way. The 27- year-old was born with six toes on each foot — an extra toe on the side of each of her big toe and was diagnosed with preaxial polydactyly or what her parents believed at the time to be a severe birth abnormality. Adam’s was born with six toes on each foot, however, correctional surgery did nothing to help Adam’s unanswered questions. His sister was also born with preaxial polydactyly. “I had a lot of unanswered questions growing up. I didn’t even know they called it polydactyly.
All I knew was that my toes weren’t normal. They were at a 90 degree angle; they were very wide apart and ugly. My parents had the problem corrected when I was about one year old but growing up I had a lot of problems wearing shoes. My left shoe had to be bigger than my right shoe. But that was the least of my problems because there I had a lot of discomfort because of the angle of my toes,” Adams said. I have come to accept my toes. I do regular pedicures and my boyfriend accept me as I am, so now I don’t see it as a problem. I am just happy to know what it was because I didn’t know the correct term for my unusual toes,” Adams said.
Ayanna Kinsale, 30, who has an extra digit on her left “pinky” finger said a sixth finger has been a blessing. Kinsale was born with two extra digits on each of her pinky fingers, which is the most common form of polydactyly in which is a small, soft, extra finger that contains no bone. I think it’s hereditary. My brother was born with six fingers on each hand on the pinky finger. My aunt also was born with extra digits. My mother never made the decision to cut our extra digits. It was never a problem for me personally. In school my friends were curious about it but it so it was cool. It got me a lot of attention and it was positive. I never felt embarrassed as a child; I even allowed my friends to play with it,” Kinsale said. Kinsale also admitted that she never heard the medical term polydactyly until now. I just thought it was an extra digit,” she said.
The website webmd.com explains that polydactylism, or having one or more extra fingers or toes, is probably the most common abnormality of development found at birth. Having an abnormal number of digits (six or more) can occur on its own, without any other symptoms or disease. While polydactylism can be seen in conjunction with other birth defects, the majority of cases are not associated with any other physical abnormalities. Polydactyly may be passed down (inherited) in families. The most common form of polydactyly is a small, soft, extra finger that contains no bone.
Many of these can be easily treated at birth by the attending physician who ties a suture tightly around the base. The extra digit falls off, and the normal-appearing hand or foot heals quickly. If there might be bone in the extra digits, X rays should be obtained to give a clear picture of what is going on. In some instances, it is still difficult to decide which digit should be removed, and close observation of the function of the hands and feet as they develop can give the answer.
Complex polydactyly is usually not repaired until a child is one year old. Generally, the digit that is best aligned with the long bones is saved. When the other digit is removed, sometimes transferring tendons from the amputated digit will make the one that remains more normal. Sometimes a joint need to be reconstructed or a bony prominence shaved. If the case is complex, an orthopaedic or plastic surgeon with expertise in hands and feet is preferred.
The Express spoke to Dr David Toby who has vast experience treating children with polydactyly. The orthopaedic surgeon provides expert care to patients at the Princess Elizabeth Centre on a regular basis. He said “Polydactyly is most common on the little finger and in severe cases mostly with the toes, you can get extra digits on every finger but most times it is the little finger. We see it often on upper limb or lower limb. If left untreated it could cause severe handicap. Such cases could negatively impact on a child’s social life.
“The primary issue in most types of polydactyly is the function of the hand and digits; appearance of the hand is also an issue, but it is secondary to function. It is more difficult to deal with the feet because sometimes you get double toes so you have to split the toe,” Toby said.
One of the major problems with polydactyly is foot wear.
“Sometimes the toe is at a 90 degrees the angle it’s very difficult to get foot wear. Wearing shoes is difficult. If it happens on one foot and not the other it means that the child has to have two sets of shoes. You have to have a bigger shoe for one foot and smaller for the other foot and that is difficult. Some patients also experience pain and discomfort as the toes rub against the shoe, so foot wear is the most difficult problem,” Dr Toby said.
Many cases seem to occur without an apparent cause and he noted that most parents opt not to seek treatment for their children for varying reasons. “If severe cases are left untreated it causes a major handicap. Most people opt not to have correctional procedure done and sometimes it is for religious reasons. Some people are superstitious about it; they believe that whatever you are born with you have to go back with. It could be hereditary but it doesn’t have to be, because most times it’s not,” Dr Toby said.