Pre-axial mirror polydactyly associated with tibial deficiency: A study of the patterns of skeletal anomalies of the foot and leg

Renjit Verghese,Hitesh Shah,Benjamin Joseph,Gleeson Rebello

doi:10.1007/s11832-006-0001-5

Renjit Verghese, Hitesh Shah + Show 2 more

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https://doi.org/10.1007/s11832-006-0001-5

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Abstract

The study was undertaken to identify the patterns and spectrum of aberrant development of the skeletal elements of the leg and foot in children with pre-axial mirror polydactyly of the foot. Case records and radiographs of eight children (ten feet) with pre-axial mirror polydactyly were studied. Four feet were seen in association with fibular dimelia, three feet with dysplastic trapezoid shaped tibia, two with tibial aplasia and one with tibial hypoplasia. Distinct patterns of anomalies of the hindfoot, midfoot and forefoot were noted, with different patterns of leg malformation. Fibular dimelia was associated with duplication of the calcaneum, cuboid and the lateral cuneiform. Talar duplication occurred in children with a trapezoidal tibia. No duplication of tarsal bones was seen in association with tibial aplasia or hypoplasia. The first metatarsal was hypoplastic wherever the tibia failed to develop. Mere resection of the supernumerary rays resulted in a near normal looking foot in feet without calcaneal duplication. The cosmetic appearance of the foot was poorest in children with fibular dimelia.

Highlights

Pre-axial mirror polydactyly of the foot, which is known as mirror foot or diplopodia, is a very rare congenital anomaly usually associated with major developmental defects of the leg such as fibular dimelia [1,2,3,4,5,6,7,8,9,10,11,12,13], tibial aplasia [14,15,16] or dysplasia [15]
Four patterns of anomalies in the leg were seen in these patients; fibular dimelia in four limbs (Fig. 1 a), total tibial aplasia in two limbs (Fig. 1b), dysplastic tibia with a trapezoidal configuration in three limbs (Fig. 1c) and a hypoplastic tibia in one limb (Fig. 1d)
In the three feet with tibial aplasia or hypoplasia, there was one talus and one calcaneum (Fig. 3a), in the three feet with dysplastic trapezoidal tibiae the talus was duplicated but there was only a single calcaneum (Fig. 3b), and in the four feet with fibular dimelia there was a single talus with calcaneal duplication (Fig. 3c)

Summary

Introduction

Pre-axial mirror polydactyly of the foot, which is known as mirror foot or diplopodia, is a very rare congenital anomaly usually associated with major developmental defects of the leg such as fibular dimelia [1,2,3,4,5,6,7,8,9,10,11,12,13], tibial aplasia [14,15,16] or dysplasia [15]. Though reports of fibular dimelia and tibial aplasia mention the association of these anomalies with mirror polydactyly of the foot, little attention has been paid to the foot deformity per se. One reason for this may be that several authors opted to amputate the affected foot or the leg [4, 6, 9] on account of the severity of the associated anomalies of the leg. Over the last 10 years we have encountered ten feet with pre-axial mirror polydactyly in eight children who had a spectrum of associated anomalies of the involved limb. We studied these children to: (1) describe the spectrum of aberrant development of the skeletal elements in the feet, (2) determine if the patterns of anomalies of the feet are related to the type of anomaly in the leg, and (3) determine if the pattern of different anomalies of the foot has a bearing on treatment planning

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