The syndactyly is a very common deformity that occurs in the 4th and 5th toes, 3rd and 4th toes, 1st and 2nd toes, and 2nd and 3rd toes, or in severe cases, the 1st to 5th toes are all joined together. In some cases, the syndactyly is accompanied by multiple toes, commonly 4 or 5 toes with multiple toes of the little toe. The onset of the disease is related to genetic factors and may be caused by embryonic local developmental arrest and blocked toe differentiation. Clinical manifestations 1. Soft tissue syndactyly: normal skeletal development, intact joints, basically normal flexion and extension, only the soft tissue of the skin is connected. In mild cases, the two toes are only too shallow, but in severe cases, the two toes are very close to each other, the skin is very tense, and even the toenails are connected together, with the appearance of a giant toe, but the X-ray shows that the bones are completely separated. 2, bony toe: two toe bones merge, lighter only part of the toe bones adhere, generally near one or two separate, the end of the toe bones connected, some toenails together. In severe cases, the two toe bones are completely fused, and even the joints do not exist, treatment is more difficult. 3, and toes combined with multiple toes: common for 4, 5 toes combined with small toes multiple toes, or 1, 2 toes and toes combined with bunions multiple toes, some bone and joint deformity is heavy. Treatment principles 1. Separate the syndactyly and repair the normal appearance and function so as to facilitate walking in shoes. 2. The surgical method and time should be determined by the degree, type, age and location of the deformity. Soft tissue syndactyly can be operated at the earliest age of half a year; bony syndactyly is usually operated at the age of about 1 year; syndactyly with multiple toes can be operated at the age of half a year if the osteoarthritic deformity is not severe; osteoarthritic deformity is severe at the age of 1-3 years. Special note: If you review the literature, you may find that the best age for surgery is much older than I have stated, or even that you should not have surgery until you go to school. I dare not say that there are many doctors who simply copy the outdated theories of the old-timers, but I would like to say that based on my 18 years of experience and a survey of syndactyly cases in our hospital for the past 10 years, I have come to the conclusion that older children who walk in shoes have a higher chance of severe scar growth after syndactyly surgery due to friction between the toes, and some children even have to be operated on again to remove the scar implant, and after the re-operation The scar may still recur after the surgery. The toe scar will be painful when walking due to friction and will end up in a situation where it is better not to do it. In contrast, the scar growth is rarely apparent in young infants who are not yet walking at the age of 1 year after syndesmosis surgery. Therefore, I advocate that it is best to operate within 1 year of age, and no later than 3 years of age. 3, surgical methods (1) toe Pu Z shaping method: for the more relaxed webbing too shallow part of the parallel toe, Z shaping generally does not cause skin defects, do not need skin implants. (2) Toe separation full-thickness skin grafting method: applicable to most soft tissues and part of the bony syndactyly, at the dorsal side of the base of the syndactyly, rectangular skin flap is designed to shape the toe, serrated incision is made to separate the syndactyly, forming staggered skin flap part can be sutured to the inlay, and the remaining skin defect area is repaired by full-thickness skin grafting. In the case of multiple toes, it is generally not advisable to do this at the same time on both sides of the same toe to prevent blood flow and necrosis of the affected toe. If there is a toe with multiple toes, according to the x-ray performance, decide the multiple toes that need to be removed, you can use the skin of the multiple toes to repair the skin defect between the separated toes. (3) Flap method: In severe complete bony syndactyly (very rare), the exposed area of the toe bone is too large to be covered by a flap and the bone cannot be repaired with skin implants, so a tipped flap transfer should be considered.