People with Syndactyly have a congenital malformation of the hands and feet. Fingers and toes that have grown together are noticeable. Syndactyly can occur alone or in conjunction with other hereditary diseases.
What is Syndactyly?
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In the Syndactyly a malformation of the hands or feet occurs in the embryonic development phase. The separation of the toes and fingers, which takes place between the 5th and 7th week of development of the embryo, is disturbed.
Syndactyly is one of the most common hand malformations, because simple syndactyly affects about one in 3000 newborns. The term comes from the Greek: "Syn" means together and "dactylos" fingers, which consequently have grown together. In extreme cases, this applies to all fingers on one hand. The third fold between the fingers is most commonly affected on the hand and the second fold between the toes on the feet.
Individual phalanges of the toes and fingers do not divide completely. Syndactyly is relatively common. Due to the disease, the mobility of the fingers is limited. If all fingers are affected, the normal gripping function is not possible. This is known as what is known as the spoon hand. This malformation is often a genetic disease (Apert syndrome).
It is the most common malformation of the hand. Syndactyly is differentiated according to the degree of the affected limbs: For example, cutaneous syndactyly can result in a connection only of the skin between the affected limbs. In osseous syndactyly, however, parts of the bones fuse together. The separation is possible in most cases of syndactyly and is carried out if possible before the end of the 3rd year of life.
causes
The cause of the Syndactyly is in the genetic area. Those affected have a dominant gene that caused this hereditary disease. The frequency of inheritance is between 10 and 40 percent family-related.
Due to the defect, the limb sections do not separate in the intended development phase of the embryo. Syndactyly is not just an isolated disease. In many cases it is an accompanying symptom of other genetic diseases. What they all have in common is that they influence the normal development of the embryo.
Syndactylia are only developed to a very small extent in later life. In these cases it is exogenous syndactyla. Mostly they go back to an injury or an accident, as a result of which the healing of the skin or bones was not medically correct or could not be treated.
Symptoms, ailments & signs
The syndactyly is primarily noticeable through the malformations of the hands and feet. The affected person's fingers and toes have grown together, resulting in problems moving and grasping. Depending on the extent of the disease, even simple movements can no longer be performed.
In the long term, the syndactyly leads to considerable restrictions in everyday life. In the later course of the disease, bony connections form between the fingers and toes, which can be felt externally and which restrict the mobility of the joints. In so-called acrosyndactyly, fingers or toes of different lengths occur.
Then holes form in the skin bridge, which can become inflamed. Syndactyly and acrosyndactyly mainly affect aesthetics, although movement restrictions can develop in the further course of the disease. Especially in the case of a serious illness, there is a risk that serious complications arise as a result of the fused limbs.
In the absence of treatment, fine motor skills and the sense of touch deteriorate increasingly. The affected children often suffer emotionally from the aesthetic abnormalities. Then social fears or even depressive moods can develop. An early operation can completely eliminate the symptoms.
Diagnosis & course
The Syndactyly can be determined by visual examination after birth. Imaging tests are then used to determine the type of syndactyly present. In this way, the connecting bone bridges in osseous syndactyly can be determined more precisely.
The syndactyly can usually already be recognized prenatally during the preventive examinations of the pregnant woman. This enables the child's parents and the treating doctors to adapt to the syndactyly at an early stage. In the area of the toe phalanx, it is mostly an aesthetic problem that has no influence on the child's development.
The course of syndactyly on the phalanx is different. Children need the ability to grip in order to be able to develop in an age-appropriate manner. The untreated syndactyly on the hands can lead to developmental disorders.
Complications
In syndactyly, the fused fingers and toes are the primary cause of complications. Depending on how severe the malformation is, the affected children may not be able to cope with everyday tasks without outside help. This can mean that those affected develop much more slowly than their peers and only become really independent late in life.
If the child is not helped, this can lead to developmental disorders, as fine motor skills and the sense of touch are not adequately promoted. Often those affected also suffer from the cosmetic abnormalities associated with syndactyly and withdraw from social life at an early age. Teasing and bullying cannot be ruled out either. Surgical treatment of the malformation can always cause complications.
In the course of surgical interventions, for example, nerve injuries, infections and bleeding occasionally occur. Wound healing disorders and secondary bleeding can occur after an operation. Due to the scarring, the aesthetic impairment may be even more noticeable than before. Finally, the prescribed medication also carries a certain risk. In children in particular, an incorrect dosage or an undetected previous illness can quickly lead to unexpected side effects or interactions.
When should you go to the doctor?
Malformations or mutations in the limbs are usually diagnosed immediately during or after the birth. In many cases, the preliminary examinations during gestation can reveal irregularities in imaging procedures. For this reason, expectant mothers should take part in all available examinations during pregnancy. These enable early detection and, if possible, the first treatment steps.
If abnormalities were noticed before the birth, an inpatient birth is often recommended. The obstetrician team present takes over the initial examination of the offspring independently and on its own responsibility. The parents do not have to take any action in these cases, but should be available to the treating physician so that the necessary decisions can be made as quickly as possible.
Midwives or helpers are also present in the event of a birth in a birth center or a home birth. As with a birth in a hospital, they take care of the initial examination of the child. The malformation of the fingers and toes is determined by visual contact. A doctor is then informed about the health problems by the obstetricians present.
Here, too, parents do not need to take any further measures, as these are taken over by the medical supervisors themselves. In rather rare cases, a spontaneous birth occurs when no nursing staff is present. A doctor should always be consulted immediately after the birth.
Treatment & Therapy
Treatment of the Syndactyly consists of surgical interventions to separate the fused limbs. This mainly affects the phalanges of the fingers, as the separation there goes beyond an aesthetic correction.
The operation takes place very early. If the syndactyly is only cutaneous like a webbed skin, an operation is very unproblematic. It is more difficult when the fusion of the bones is so pronounced that two limbs with the same bone structure cannot be identified. During the separation operation it must also be taken into account that the changes usually also affect the nerves and vessels (arteries and veins).
Therefore, careful separation is required. In the case of syndactyly of the toe phalanx, treatment is often foregone and the decision is left to the person concerned. Many people with toe phalanx syndactyly do not have surgery at all. You do not find the limbs that have grown together disturbing.
Depending on the degree of syndactyly, surgery is not advisable, as the aesthetic impairment caused by the scarring can be even more noticeable than the previously existing deformation.
prevention
A prevention against that Syndactyly can not. It is a genetically determined deformation that is already created in the embryo. Even with a prenatal diagnosis, however, there is no reason for the child's parents to be more concerned if further illnesses have been excluded. Syndactyly on the feet is a visual impairment that has no consequences for children. Surgical treatment of syndactyly on the phalanges can also be carried out in infancy.
Aftercare
Follow-up treatment is important if the fingers or toes that have grown together have been separated from one another by surgery. The focus is on dressing technology. If the bandage is too small, there is a risk that a child will unintentionally remove it during the night. Therefore, after syndactyly surgery, the dressings should be large enough, which requires a certain amount of effort.
If the toes were separated during the syndactyly operation, the patient wears a special shoe for a period of two to three weeks. Follow-up care can be carried out by a resident doctor who has already gained sufficient experience with this type of procedure. In most cases, however, the hospital takes over the follow-up treatment due to the high effort involved in changing the bandages. The bandage is usually worn for around two weeks after syndactyly surgery. Then the threads are pulled.
To treat the pain, the patient is given an analgesic for the first one to two days. Mostly these are paracetamol suppositories. Special scar gels are administered to counteract the scars that have formed as a result of the surgical procedure. They help to keep the scars as inconspicuous as possible. After an operation to separate the toes, the use of crutches can make sense, which is ultimately decided by the attending physician.
You can do that yourself
Syndactyly is a congenital disease that can only be treated symptomatically. The affected persons need the support of a specialist and also help in everyday life.
If several fingers have grown together, surgery can be considered. However, the movement restrictions often remain permanent. The most important measure is to regularly do movement exercises. If circulatory disorders occur, the doctor must be consulted. If these measures do not bring any improvement, it is best to speak to the doctor again. Sometimes the disorder is so pronounced that an improvement in mobility can no longer be achieved. Then supporting aids must be used to compensate for the restrictions.
An operation is usually performed before the child is three years old. From now on, parents must carefully watch the child's hand and finger movements and compensate for them if necessary. Joint deformation can be avoided by early medical treatment, especially if fingers are not of the same length. The prerequisite is that the child receives medical support after the procedure. It is the parents' responsibility to monitor the course of the disease and the use of any prescribed pain medication.
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