Abstract
PurposeBiphalangealism of the toes is an exclusively human phenomenon. The aim of this study was to evaluate the development of the lateral toes in childhood by following the ossification pattern of the phalanges.MethodsFoot radiographs of 913 adults have been evaluated for biphalangealism of 3rd to 5th toe. The pediatric group, aged 6–15 years of age, was assessed for the number of ossification centers in the foot.ResultsIn adults, the mean prevalence of biphalangealism in the 5th toe was 41.39%, in the 4th toe was 2.15%, and in the 3rd toe was 0.48%. In children, 45% feet had four ossification centers in the 5th toe. The epiphysis center of the middle and distal phalanx was missing. In the 4th toe, four centers were present in of 2.47% of cases. Those values are similar to the prevalence of the biphalangeal toes in adult population. The remaining toes had 5 or 6 ossification centers. In the 5-center toe, the epiphysis of the middle phalanx was missing.ConclusionA missing distal phalanx epiphyseal ossification center is considered indicative of a biphalangeal toe, and the toes with 5 or 6 ossification centers are indicative of triphalangeal toes. The reason for such evolution of the lateral toes is still debated, but the differences in anatomy most likely have no impact on foot function.
Highlights
A classical anatomical view of a human foot is a biphalangeal hallux and triphalangeal lesser toes, being a mirror of the human hand
This information is not widespread among clinicians and can lead to a misdiagnosis, when a fracture of a distal phalanx can be mistaken for a normal triphalangeal 5th toe [5]
There even have been attempts to prove that the prevalence of the biphalangeal 5th toe has increased over the last century [4, 6]
Summary
A classical anatomical view of a human foot is a biphalangeal hallux and triphalangeal lesser toes, being a mirror of the human hand. The biphalangeal 5th has been evaluated in several studies and it has been shown that it is common variant [1,2,3,4]. This information is not widespread among clinicians and can lead to a misdiagnosis, when a fracture of a distal phalanx can be mistaken for a normal triphalangeal 5th toe [5]. Biphalangealism of the toes is an exclusively human phenomenon. The evolution of biphalangeal lateral toes is considered an adaptation to bipedalism, since human is the only bipedal mammal [3]. There even have been attempts to prove that the prevalence of the biphalangeal 5th toe has increased over the last century [4, 6]
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