Cleft foot: A case report and review of literature

Abstract

Background: Cleft foot is a very rare congenital anomaly, which is characterized by central rays deficiency of the foot. It is also known as split foot or ectrodactyly of the foot, and it is very often combined with splitting of the hands. The defect develops due to insufficient activity of the median apical ectodermal ridge, which leads to an increase in cell death or a decrease in cell proliferation. Due to the rarity of the pathology, there are few papers on the surgical treatment of this congenital foot disease, and publications to date concern the treatment of children.

Case summary: We present a clinical case of congenital splitting of the feet and hands in a 31-year-old woman and a long-term result of foot treatment using the minimal arrangement of the Ilizarov apparatus. The patient had paternal inheritance of the trait. After the surgical treatment, cosmetic view and functional condition of the foot were improved and persisted two years after intervention. There were no complications in the treatment process.

Conclusion: The possibility of dosed control and stable fixation of the foot rays made it possible to create favorable conditions for the healing of the central wound and the closure of the segment splitting without complications. The long-term outcome of the treatment of foot congenital splitting using the proposed Ilizarov apparatus arrangement has shown its effectiveness. Our approach should be considered as an option of treatment in similar cases.

Keywords: Case report; Cleft foot; Congenital malformation; Ectrodactyly; Ilizarov; Split foot.

Figure 1

Photo and x-ray pictures of patient’s feet before treatment. A: Cleft feet; B: X-rays of feet in anterior-posterior and lateral view (absence of central feet rays).

Figure 2

Photo and x-ray pictures of patient’s hands. A: Split hands with absence of fingers 1-4; B: Three metacarpals with transverse bone in base of cleft and absence of fingers 1-4.

Figure 3

Scheme of surgical intervention, x-rays of left foot and photo of feet during treatment process. A: The first step was resectional wedge-shaped osteotomy of cuboid and cuneiform bones with removing of rudiment of central foot ray. The second step was corrective osteotomy of both metatarsal bones; B: Correction and fixation of foot rays by minimalist construct of Ilizarov apparatus; C: Closure of foot splitting.

Figure 4

Photo of feet and x-ray pictures of patient’s left foot after 2 years after surgical intervention. A: Closure of foot splitting; B: X-rays of left foot in anterior-posterior and axial view.