Webbed fingers and toes: Proper surgery for the best outcome

A child born with four fingers webbed together. This picture was taken after the first surgery to release two fingers (the little finger and finger next to thumb) had been done, by a plastic surgeon at Rwanda Military Hospital./ Courtesy photo

Webbing of fingers and toes, also medically known as syndactyl (pronounced as sin-dack-til-e), is the most common abnormality of the new-born hand. It is a condition when a baby is born with two or more fingers or toes, or both stuck to each-other.

It can happen either as an isolated abnormality, or as part of other associated medical conditions

In the first few days of pregnancy, the fingers aren’t separate from one another and in fact, the digits (toes or fingers are stuck to one-another) and by the 7th week of pregnancy, these digits start to separate from one another with this separation starting from the tips of the digits going down to the palm or foot. And these digits are normally fully free from one another by the 8th week of pregnancy.

Hence, this webbing of the digits is not caused by the fingers sticking together in the womb as mistakenly perceived by many people, rather, is caused by failure of these digits to separate during the sixth to eighth weeks of pregnancy.

There is no specific cause of this webbing, although up to 40 per cent are linked to genetic inheritance running in families while some happen at random.

Worldwide, the incidence of this condition is approximately one in 2,000 live births, more common in people of Caucasian ancestry, and boys are twice at increased risk of developing the condition compared to girls. The most frequently webbed digits are the long and ring fingers (accounts for about 50 per cent) and the second–third toes (counting from the big toe) in the foot.

This condition can affect the functioning of the child’s hand differently, depending on the specific number of affected fingers. It may cause little or severe functional impairment to the child’s hands.

When two fingers or toes of great unequal length are joined together, delay to intervene and correct the abnormality will restrict the longer finger or toe from growing well and might become curved and deformed.

Surgery is the only treatment option to this condition, and the timing of surgery will depend on a number of factors, such as the type of fingers affected, and the type of webbing, whether it involves the bones of the fingers or not. For webbing that involves the thumb, surgery to correct the condition should ideally be done before six months of age for the best outcome while for other fingers and toes; surgery is best done by two years of age.

It is very important to know that attempts to separate these webbed fingers and toes by many clinicians with less experience in these operations has led to many complications being referred. Unfortunately some of these complications are severe and irreversible at the time the patients get to our specialised centres for intervention, leading to loss of fingers or toes.

This type of surgery should be ideally performed by a plastic surgeon or in absence of a plastic surgeon, should be by a surgeon who has attained some special training in such operations to avoid complications.

In such scenarios when multiple fingers are webbed, surgery is done in phases to avoid the likely complications which arise if all fingers are operated at once.  Another surgery to successfully release the remaining webbed fingers is then done after the healing of the first separated fingers.

Dr Ian Shyaka ,  Resident in Plastic surgery.

Rwanda Military Hospital,

iangashugi@gmail.com