The purpose of this study was to focus on the problems associated
with macrodactyly of the foot and to formulate guidelines for optimum
Seventeen feet (fifteen patients) with macrodactyly formed the
basis of this retrospective review. The feet were classified into
one of two groups, depending on whether the macrodactyly involved
only the lesser toes (group A) or involved the great toe with or
without involvement of the lesser toes (group B). Toe amputation
or ray resection was usually done to reduce the length and width
of the foot in group A, whereas the length of the first ray was
reduced by epiphysiodesis or amputation of the phalanx in four of
the five feet in group B. In both groups, soft-tissue debulking
was an integral part of the treatment. The severity of the macrodactyly
and the effect of treatment were documented radiographically by
measurement of the so-called metatarsal spread angle. At the latest follow-up
evaluation, each foot was graded with regard to pain and shoe wear.
Toe amputation was performed in six of the twelve feet in group
A and toe shortening was performed in two, but only three of those
procedures had a good result. Ray resection was performed in five
feet (as an initial or secondary procedure) in Group A, and all
had a good result. The mean reduction of the metatarsal spread angle
was 10.0° following resection of a single ray in Group A.
In Group B, four of the five feet were rated as having only a fair
result because shortening alone did not effectively reduce the size
of the great toe. The macrodactyly of the great toe was not treated
in the fifth foot, which also had a fair result.
Toe amputation, which is cosmetically unappealing, is not effective
for treating macrodactyly of the lesser toes and does not address
the enlargement of the forefoot. Ray resection results in the best
cosmetic and functional outcomes in feet with involvement of the
lesser toes. When the great toe is involved, the result is often
only fair, and repeated soft-tissue debulking may be necessary.