Foot Oligodactyly as the Main Dysplasia in Children

Abstract

Introduction Foot oligodactyly is usually associated with fibular insufficiency or cleft foot syndrome. A foot with a reduced number of rays may occasionally have an isolated dysplasia. Methods We reviewed the clinical notes and X-rays of six children with oligodactyly, having a normal development of the tibia and fibula. Clinical evaluation recorded the plantigrade or deviated foot, appropriate shoe wear, and aesthetic presentation of barefoot children. Radiological examination revealed missing or hypoplastic bones in the foot, the presence of other deformities, and leg length discrepancy (LLD) of the affected limb. Results On clinical evaluation, all children except one had a plantigrade foot with normal shoe wear; the lesion was not spotted in three of them unless informed of the presence of the dysplasia. Radiological examination in four of them revealed the absence or hypoplasia of the navicular, with a normal shape of the first metatarsal. Calcaneocuboid joints were normal in five of them; LLD was the main problem in three children. The girl with bilateral oligodactyly presented as a normal child. Conclusion Oligodactyly may present as an isolated dysplasia. LLD in these patients, which is less severe than in children with fibular or tibial insufficiency, is the main issue that requires surgical management in later life. Prenatal diagnosis of oligodactyly as an isolated dysplasia is an important feature for appropriate counseling of parents.

Keywords: absent foot rays; fibular hemimelia; foot dysplasia; leg length discrepancy; oligodactyly.

Figure 1. 1st patient's feet at the age of 2 years.

Figure 2. 1st patient's feet at the age of 7 years - anterior view

Figure 3. 1st patient's feet at the age of 7 years - posterior view

Figure 4. X-ray of 1st patient's feet with bilateral involvement at the age of 2 years. Normal development of the tibia and fibula. Delayed initial ossification of the navicular.

Figure 5. X-ray of 1st patient's feet at the age of 7 years with an enlarged navicular, with a coalition of the talus navicular, and normal bilateral calcaneocuboid joint. There are two cuneiforms present.

Figure 6. 2nd patient's unilateral oligodactyly, with a marginally smaller foot, difficult to be spotted unless it was notified at the age of 1 year.

Figure 7. 2nd patient's unilateral oligodactyly, with a marginally smaller foot, difficult to be spotted unless it was notified at the age of 5 years.

Figure 8. X-ray of the 2nd patient's feet, with a smaller length of the metatarsal at the age of 1 year.

Figure 9. X-ray of the 2nd patient's feet, at the age of 5 years with a calcaneocuboid coalition of the right foot, two cuneiforms, and complete absence of the navicular.

Figure 10. X-ray of the 3rd patient's feet, with normal calcaneal cuboid joint, hypoplastic navicular, and presence of three cuneiforms.

Figure 11. X-ray of the 3rd patient's feet with LLD 1.43 cm, and the ankle joint has a ball joint figure.

LLD: Leg length discrepancy

Figure 12. X-ray of the 4th patient with leg length discrepancy in the tibia.

Figure 13. X-ray of the 4th patient, with leg length discrepancy in the femur.

Figure 14. X-ray of the 4th patient with equinus foot, with delayed ossification of the navicular and normal cuboid bone.

Figure 15. Clinical picture of the 5th patient with a plantigrade foot with minimal difference in size.

Figure 16. X-ray of the 5th patient with fusion of the hypoplastic 2nd metatarsal to the 1st one, absent navicular, normal calcaneocuboid joint.

Figure 17. The ankle is a ball joint. X-ray of the 5th patient at the age of 5 years.

Figure 18. Clinical picture of the 6th patient's foot at the age of 6 months.

Figure 19. Clinical picture of the 6th patient's foot at the age of 3 years. There is a plantigrade foot, with LLD of 2 cm of the tibia.

LLD: Leg length discrepancy

Figure 20. X-ray of the 6th patient at the age of 6 months. Initially delayed ossification of the heel, that later appears as a calcaneum-talus coalition with hypoplasia of the cuboid.

Figure 21. X-ray of the 6th patient at the age of 3 years. There is a ball joint ankle, with an LLD of 2 cm in the tibia.

LLD: Leg length discrepancy