Macrodactyly is a congenital disease where the digits affected increase in size faster than can be attributed to normal growth of unaffected digits. Its etiology is ambiguous and hereditary patterns do not play a role. The abnormality develops in one or more toes and involves thickening of soft tissues, bone and accumulation of fat. The accepted treatment is reduction of the fibro-fatty bulk via dissection and ablation; the major aim being reconstruction of a pain-free functioning foot. Complications with surgery include delayed wound healing and inadequate initial de-fatting which could require a more proximal amputation.

1. WELCOME

3. DEFINITION
A Hamartomous Enlargement Of Soft Tissue And Underlying Bone.
Macrodactyly was first loosely coined by Feriz when he described
lymphomatous degenerative lesions and called them
“macrodystrophia lymphometosa progresiva.”

4. In the foot, the most common presentation of this pathology
consists of excessive fibro-fatty tissue on the plantar aspect
which causes dorsal curling of the toes.
Must be distinguished from other forms of Enlarged digits
1. neurofibromatosis
2. multiple enchondromatosis
3. vascular malformations

5. Associtaed
With
• Proteus syndrome,
• Banayan-Riley-Ruvalcabe,
• Maffuccin,
• Ollier’s disease, and
• Milroy’s disease.

6. EPIDEMIOLOGY
Very rare
90% unilateral
70% involved more than one digit
Index finger most commonly
involved
Affect toes
Slight male predominace

7. PATHOPHYSIOLOGY
Etiology
unknown
No genetic
correlation
known to date
Median nerve
most
commonly
involved

8. CLASSIFICATION:
Funtional
ClassificationStatic
macrodactyly:
enlarged in
proportion to the
rest of the digits
1
Progressive
macrodactyly:
enlarged out of
proportion to the rest
of the digits
Pedal macrodactyly
tends to be of the
progressive type.
2

9. FLATT classification according to PATHOLOGY
Type1:
Lipofibromatosis
01
Type II:
Neurofibromatosis
02
Type III:
Digital
hyperostosis
03
Type IV:
Hemihypertrophy
04

10. PRESENTATION:
1
History of
asymmetry to digits
can be present at
birth or appearing
over time
2
Pain
3
Inability to use
digits
4
Complaints of
cosmetic issues

11. IMAGING
Radiographs
01
CT MRI
(not typically
needed)
02
Angiography
( for surgical
planning)
03

12. Treatment Options: Aim is the reconstruction
of a pain-free functioning foot.
Non operative:
mild case
(observation)
Operative: unrewarding!
1.Staged debulking
2.Epiphysiodesis
3.Osteotomies & Shortening procedure
4.Amputation

13. BEAWRE
Ampuatation may be the best options but
an adjacent digits may start overgrowing!

14. tAKE HOME
MESSAGE
• Macrodactyly is a congenital disease in which
the soft tissue, bone, or fat of the digits affected
is enlarged.
• Due to the rarity of the condition, the prevalence
is unknown.
• There is not much known about this deformity,
including the etiology.
• Surgical options vary, and include but are not
limited to debulking of the soft tissue and fat,
partial osteotomies, and amputations.
• However, each deformity must be treated on a
case by case basis.

15. REFERENCES
Apley’s system of
orthopaedics and
fractures
01
The foot and
ankle journal
02
Internet
03