Postaxial polydactyly is the formation of an extra fifth toe or finger, which can occur due to genetic errors or fetal development problems. It can be treated shortly after birth or left for the patient to decide later in life. There are two types, with type A having a fully formed and functional extra digit, while type B has a coarser, non-functional extra digit. Treatment options are available, and historically, extra digits were associated with superstitions.
Postaxial polydactyly is the formation of an extra fifth toe on the hand or foot. It can occur independently as a random genetic error or a problem with fetal development and can also be associated with a larger genetic syndrome that can include other manifestations. Many cases of postaxial polydactyly are treated shortly after birth with removal of the extra finger. Some parents may choose to leave the extra finger in place until later in life, allowing the child to make an adult decision about treatment.
There are two distinct forms of this condition. In type A postaxial polydactyly, the extra finger is fully formed and functional. It has bones and articulates with the bones in the hand or foot, allowing the patient to move it and use it in gripping and manipulating tasks. Sometimes this finger articulates with the existing fifth metacarpal, and in other cases the metacarpal bone is also duplicated, creating a new joint point for the extra toe.
Patients with the type B form of this condition have an extra coarser finger or toe. It may lack bone, consisting of a small lump of extra tissue, and it may lack nerves and the ability to articulate. These cases sometimes require treatment because the extra toe gets in the way, as the patient cannot move it while using their hands or feet. The finger may protrude from the side of the hand or foot, or from the fifth finger or toe itself.
This condition is not uncommon, although the incidence of adults with postaxial polydactyly is rare because treatment is often treated in infancy. Patients considering surgical treatment may meet with a hand or foot specialist to discuss the nature of the case and learn about treatment options. The growth can usually be removed with minimal scarring. The levels of pain and discomfort during healing depend on the location and whether it is polydactyly type A or B.
Historically, some superstitions surrounded people with supernumerary digits as seen in postaxial polydactyly. Sometimes fingers and toes were used as evidence of witchcraft or other suspicious activity, and sometimes extra digits were added after the fact to make people look more wicked. Anne Boleyn, for example, was reported to have an extra little finger in smear campaigns that began after her fall from royal favor, although there is no evidence of her actually having postaxial polydactyly.
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