A LARGER THAN LIFE TOE TALE: A CASE REPORT ON MACRODACTYLY

Abstract

Macrodactyly is a rare congenital deformity characterized by hypertrophy of the bones and surrounding soft tissues in one or more digits.  The terms “macrodactyly”, “megalodactyly”, and “digital” or “localized gigantism” are often used synonymously ^[1,2]. The condition seems to affect slightly more boys than girls, and it may occur only on one foot or on both feet, and it may be symmetrical or asymmetrical.Macrodactyly may occur as an isolated defect in either the hand or the foot, or it may present as an element of conditions, such as Proteus syndrome, Klippel-Trenaunay syndrome, Bannayan-Riley-Ruvalcaba syndrome, Maffucci, Ollier’s disease and Milroy’s disease.The enlargement includes skin, subcutaneous tissue, nerve, joint, and bone.The bony involvement is usually limited to phalanges ^[3]. There are two types of macrodactyly: static and progressive. The progressive variant is more frequently seen in the foot than in the hand. Radiologically, X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) are used to determine the size of lesions, involvement of soft tissue and bone, which are important for surgical treatment planning.  In macrodactyly, reconstruction is aimed at decreasing the size of the foot in normal size and shape as much as possible. Many surgical options are available for the treatment of macrodactyly of the foot: amputation, ray amputation, epiphyseal ablation, transverse and longitudinal osteotomies, nerve stripping, and extensive defatting. None of the available methods, however, give ideal functional and cosmetic results ^[4].Most patients are diagnosed and treated from childhood; however, macrodactyly might become more severe if diagnosis and treatment are delayed for a long time. In this case, we report a rare case of long-term (23 years) macrodactyly of a toe resulting from delayed treatment.