A 21-year-old Chinese man, Ajun, was born with four extra toes on his left foot, giving him nine toes in total, which in medical jargon is called Polydactyly.

He spent 21 years of his life hiding his foot in closed footwear, avoiding sandals and slippers. Moreover, due to the embarrassment of being a deviation from normal, he avoided social gatherings and girls!

What makes this a rare case?
The number of digits for one, and twenty-one years with these for the other.

Polydactyly is the most common congenital anomaly of the forefoot, occurring during the first trimester of pregnancy. Extra digits are most commonly on the lateral side (80%), six in number, with predilection towards African-American men. 50% of cases are bilateral.

Polydactyly is usually diagnosed and operated during infancy, ideally between 9-12 months of age, making this case a rare one. Some individuals present later when cosmesis becomes the main concern.

Ajun was also diagnosed at birth, but his parents listened to the fortune teller who related extra digits to good luck, but after 21 years Ajun defied and decided in favor of his foot.

Why wait a year before surgery?
Ideally, it should be operated when ossification has occurred so that anatomical assessment can be accurately done, this is to minimize effects on development and walking.

It should be managed within a year and no later than six years to avoid a child from psychosocial trauma.

Pre-Operative Assessment:
When Ajun was examined, the big toe was replaced by two smaller ‘v’ shaped toes. Other toes had sprouting of smaller toes in between. Pre-operatively, it is imperative to perform imaging of the affected limb to be well aware of the anatomy.

Surgery:
His surgeon, Dr. Wu Xiang, from Shunde Heping Surgical Hospital in Foshan, along with his team took nine hours to remove and reconstruct Ajun’s digits along with rebuilding his confidence.

He said, ‘His most natural-looking toe is on the outside, so we decided to migrate it inwards to its most ideal position, replacing his fifth digit and creating a new big toe’, he further said ‘It’s very rare to see such a deformity having not been treated in a 21-year-old patient.’

Post-operative Care:
Patients should be monitored and evaluated. A cast walking cast is used in toddlers to keep their activity unaffected and also to protect the incision. In others, soft dressing or K-wire can be used, the latter is to be kept in place for 4-6 weeks.

Usually, the surgery is successful but few people might experience subluxation of the metatarsal head, pain, and angular or residual deformity.

Ajun’s surgery was uneventful, followed by a few weeks of observation at the hospital.
He was satisfied and thrilled to set his perfect foot back on the ground, this time with more confidence!

“I think my foot is perfect, it was worth it!” He said

References

Cara Novick, M., & Chief Editor: Jeffrey D Thomson, M. (2018, December 20). Medscape. Retrieved from Polydactyly of the Foot: https://emedicine.medscape.com/article/1260255-overview

Nwiwure, A. (2019, November 2). A Chinese Man Born With Nine Toes Was Successfully Operated To Get Rid Of The Extra Four. Retrieved from Cynbanews-home of the latest news: https://cynbanews.com/a-chinese-man-born-with-nine-toes-was-successfully-operated-to-get-rid-of-the-extra-four/