Cleft Feet Research Articles

Cleft hands and monodactylous feet: A rare variant of ectrodactyly

A 2-year-old male child presented with bilateral asymmetric cleft hands, a right monodactylous foot (diastatic type), posteriorly dislocated at the ankle joint, and a left monodactylous foot (Type VI, Blauth and Borisch) posteriorly dislocated at the ankle joint. Surgical management has enabled weight bearing and walking. Psychological problems, especially with the hands, are anticipated. Further multidisciplinary management by surgeons, physical therapists, clinical psychologists, child psychologists, and occupational therapists is advocated.

The Place of the Evil: Infant Abandonment in Old Norse Society

THE STATUS OF THE DEFORMED and disfigured in medieval Norse society is somewhat ambiguous. For instance, in Sturlunga saga we find powerful chieftains and landholders such as Porgils skardi, Skeggi skammhondung, or Halldorr slakkafotr apparently unimpeded socially by cleft palates, withered hands, or slack feet. Then, there is the Norse pantheon of the Prose Edda, which presents gods who are one-eyed (Odinn), one-handed (Tyr), and blind (Hodr). Yet, in those same source texts mutilating an opponent by, for example, cutting off a hand, handhogg, or foot, fothogg, in order to render a permanent, visible injury is a viable means of rendering disgrace. How do we reconcile these divergent attitudes particularly since the term used for both acquired disfigurements and congenital deformities, orkuml, is the same? We might ask if there is an intrinsic, negative moral valence to disfigurement and deformity in Old Norse society--in other words whether physical impairments mark its victim as disabled--a culturally rather than biologically coded category (Metzler 1987, 3-10). This study examines the special case of exposing deformed infants as prescribed in Old Norse law s. Though integrating other sources as well, emphasis is on the early Christian laws of Norway and Iceland--the oldest extant laws in Scandinavia--and the focus is, thus, on these two countries. Important discussions of infant abandonment in medieval Scandinavia are found in Pentikainen (1968), Boswell (1988), Clover (1988), Jochens (1995), Wicker (1998), Mundal (1987, 2005), Jakobsson & Sigurjonsdottir (2008), and Mejsholm (2009). In approaching a general understanding, these primarily focus on the social and economic rationale behind the practice. With regard to the detailed descriptions of impairments in Old Norse law, these remain, despite careful scrutiny, enigmatic and the object of (at times wild) speculation ranging from hard evidence of intensive inbreeding in Norway (Jochens 1998), through fantastic exaggerations meant to frighten parishioners (Landro 2010), to having a purely theoretical, interpretive significance (Mundal 1987). Since these early laws seem to capture aspects of the Christianization process, questions have arisen concerning how exposing infants with birth defects fits into the prevailing versus emerging worldviews. Is the practice's basis in Christianity or prior folk, i.e. heathen, practice? Christianity, with its emphasis on the physicality of sin, has been at the forefront of discussions (Pentikainen 1968, 1987; Bragg 1994, 2004). This study attempts to address all of these issues at some level but particularly aims at exploring what appears on the surface to be less pragmatic but equally real grounds in Old Norse society for exposing infants. Aside from economic and social motives, examining the role that fear of the supernatural and monstrous plays in exposing severely deformed infants and considering the significance this has for determining status (or lack thereof) in society are of prime importance. As far as the realism of descriptions is concerned, the laws are regarded here as serious attempts to cope with real world problems via the means and systems of understanding available at the time and are therefore not taken as flights of fancy. Rather than categorically assigning negative attitudes to one camp or the other--heathen or Christian--the middle road seems more prudent, i.e. the negative moral sense of deformities found in twelfth-century Old Norse laws likely represents a convergence of prevailing folk and Christian attitudes or is an expression of a system in flux. At any rate, with the establishment of Christian laws in Scandinavia, infant abandonment came to be categorically abolished. If anything, then, Christianity improved the chances of survival among those born with physical impairments. Reconstructing the practice of infant abandonment in medieval Scandinavia is fraught with challenges. …

The treatment of congenital foot abnormalities

With the exception of club foot, flat foot and claw foot, this paper gives a review of principal foot malformations at birth, proceeding from the available radiographical and clinical findings, and also from the facts found during surgery. In addition, there is suggested a classification of various deformities, and there are defined major guidelines and instructions for treatment. As far as the rather frequent polydactylies are concerned, the author distinguishes between a distal phalanx type, an interphalanx type, a proximal phalanx type, a metatarsal type and a tarsal type, depending on the "level", each, where distal/proximal web separation between the fingers stops. It is possible to include also rather particular forms, such as the rudimentary type and the so-called multiplications in this classification. The major indications for the surgical treatment of polydactylies are problems in finding adequate shoes, and also the aesthetic appearance. The principal concern of surgical treatment is to remove additional toes. When there is in parallel a syndactyly or a congenital hallux varus, this may require great skill in the applied surgical technique. Various approaches of surgical treatment are demonstrated by a few examples. Feet oligodactylies are primarily encountered with fibula dysplasia or aplasia, or in cleft feet. In very severe cases it is possible to find just one toe. The actual deformities alone rarely require surgical treatment, but they often "hint at" further malformations in the reach of the root of the foot (synostosis) and of the lower limb. Cleft feet are also frequently impaired in form and function, with these deformities including less severe hypoplasia of a middle toe, e. g. with a somewhat deeper web separation, toe aplasia, metatarsus hypoplasia and aplasia, synostosis, and transversal bones, and even monodactylies with only ray V existing. Additional toes in the cleft foot is one of the rare exceptions. However, the combination of cleft feet and cleft hands is rather frequently encountered. Many cleft feet are nevertheless highly efficient, even without any surgical treatment. That is why there are only indications for a surgical treatment when there are severe foot deformities or most inconvenient misalignments of peripheral toes. Some of the "lobster like" feet are so wide that it is just not possible to wear normal shoes. In this case it is recommended to have surgical correction and to close the cleft. Feet of congenital giant growth are extremely rare, but they raise most complex problems as to adequate treatment. In many cases, an amputation of the additional parts cannot be avoided.(ABSTRACT TRUNCATED AT 400 WORDS)

Analysis of anatomic variations in cleft hands

This study presents an overview of the clinical and x-ray findings observed in 54 cleft hands of 31 patients. The emphasis was on a detailed analysis of typical malformation-associated x-ray patterns such as aplasia and synostosis, with findings arranged as a function of cleft location and of the Manske and Halikis classification. The charts and radiographs of 31 patients with 54 cleft hands were reviewed retrospectively and compared with data reported in the literature. Important clinical and x-ray findings as well as the typical morphology of cleft hands were analyzed. Cleft hands were differentiated according to their location and according to the Manske and Halikis classification. In the different locations the deformities were arranged in teratologic sequences. In cleft hands syndactylies were seen in 30 of the 54 hands, most commonly between the ring and the small finger. In 3 hands polydactylies were noted. Analysis of the x-ray morphology showed 2 typical patterns: aplasia and synostoses. Location-specific teratologic sequences showed that radial cleft hands were bilateral more frequently and were associated significantly more frequently with cleft feet. Aplasias predominated in radial cleft hands, whereas synostoses were more common in central cleft hands. In terms of the Manske and Halikis classification the unilateral cleft hands often corresponded to type I whereas bilateral cleft hands with cleft feet mainly were type IV and type V deformities. Cleft hands with synostoses often were seen in types I to III whereas cleft hands with aplasias were classified most frequently as type V. Analysis of the patients' clinical data and x-rays showed differences between radial and central cleft hands, as well as between the different Manske and Halikis types.

The cleft hand. Proposal of a classification based on 279 cleft hands

We propose a new classification of cleft hand based on the analysis of our own cases and a literature search. We analysed clinical data and radiographs of 31 patients with 54 cleft hands in addition to 225 cleft hands from the literature, and classified them with the help of schematic drawings of radiographs in extension of the proposals of Blauth and Schneider-Sickert. Classification of cleft hand: 1. Median cleft hands without involvement of thumb and small finger. 2. Medioradial cleft hands with thumb affected but with detectable residuals preserved. 3. Radial cleft hands with thumb aplasia. Medioulnar cleft hands with small finger affected but detectable residuals preserved. 5. Ulnar cleft hands with small finger aplasia. Median cleft hands more frequently appear unilateral and are more seldom combined with cleft feet as medioradial and radial cleft hands. In radiographs, aplasia predominate in radial cleft hands while synostoses often appear in median cleft hands. The new classification enables us to arrange the great diversity of this malformation and takes medioulnar and ulnar cleft hands into account.

Cleft Feet

The authors studied 45 cleft feet from among their patients and 128 from the literature with regard to their roentgenographic morphology. An increasing degree of malformation was found, from deepening of a central interdigital commissure to a monodactylous cleft foot. These observations resulted in a classification of six groups based on the number of metatarsal bones. Types I and II are cleft feet with minor deficiencies, both having five metatarsals. The metatarsals are all normal in Type I and partially hypoplastic in Type II. As the degree of malformation increases, only four metatarsals in Type III, three metatarsals in Type IV, and two metatarsals in Type V can be identified. Type VI represents the monodactylous cleft foot. Of the 173 feet studied, 166 could be assigned to one of these types. Two additional forms were also found: four cleft feet with central polydactyly are described as polydactylous type, and three monodactylous feet with lower-leg diastasis or tibial aplasia or both are described as diastatic type. According to the distribution of syndactylies, synostoses, and aplasias, it became evident that cleft formation begins at the second or third ray. It then proceeds in a longitudinal direction from distal to proximal as well as in a transverse direction from tibial to fibular, while the first ray remains intact. The first ray is only missing in the monodactylous cleft foot, which possesses only the fifth ray. The defects are always larger distally than proximally. Synostoses are found only at the margin of the cleft. Cross-bones are rare and usually occur in mild cases of the deformity. Another rare feature is polydactyly.(ABSTRACT TRUNCATED AT 250 WORDS)

A Clinical and Experimental Study on Longitudinal Deficiencies in Lower Limbs in Relation to Pathogenesis of Cleft Foot

Abstract In order to determine whether cleft foot is caused by the same mechanism as tibial and fibular ray deficiencies, clinical cases of these anomalies and those in rat fetuses induced by myleran were analyzed. In tibial and fibular ray deficiencies, arrest of tibia or fibula was closely related to the missing of toes and tibial and fibular ray deficiencies can be accepted as an occurrence of so called longitudinal deficiency. On the other hand, cleft feet were frequently associated with central Polydactyly and syndactyly. In our experimental study, the critical period of formation of cleft foot was different from that of tibial ray deficiency, but it was similar to those of central Polydactyly and syndactyly. It seems that cleft foot is caused by the abnormal induction of toe rays as in cleft hand and does not belong to the same group as tibial and fibular ray deficiencies.

Hallux-to-Hand Transfer During Ankle Disarticulation for Multiple Limb Anomalies

FOR TRAUMATIC loss of the thumb, the techniques and results of hallux transfer for hand reconstruction are well established. In addition, there are several reports of toe-to-hand transfer for reconstruction of the congenitally deficient hand. Most of these cases involved transfer of a normal toe from a normal foot1; in several cases, abnormal toes from cleft feet were transferred.2,3This case report highlights the treatment of a child who was born with four anomalous limbs. He required an ankle disarticulation because of a severely unstable ankle. During the preoperative planning of amputation, the usefulness of the amputated foot tissues for hand reconstruction was discussed, and a microsurgical hallux-to-hand transfer was performed at the time of ankle disarticulation. Report of a Case The patient had four anomalous limbs at birth. No specific etiologic factor could be identified. The left upper limb had syndactylous ring and little fingers; the thumb,

Cleft Palate, Hare Lip, Dacryocystitis, and Cleft Hand and Feet

Cleft Palate, Hare Lip, Dacryocystitis, and Cleft Hand and Feet

CLEFT PALATE, HARE LIP, DACRYOCYSTITIS, AND CLEFT HAND AND FEET

CLEFT PALATE, HARE LIP, DACRYOCYSTITIS, AND CLEFT HAND AND FEET Get access E. A. COCKAYNE, D.M., F.R.C.P E. A. COCKAYNE, D.M., F.R.C.P Search for other works by this author on: Oxford Academic Google Scholar Biometrika, Volume 28, Issue 1-2, June 1936, Pages 60–63, https://doi.org/10.1093/biomet/28.1-2.60 Published: 01 June 1936