Macrodactyly, Hemihyperplasia, and the Dysmorphic First Ray

Congenital overgrowth disorders of the lower extremity have been rarely reported in podiatric literature. Since the 1980s, however, advancements in genetics and diagnostic imaging have allowed for a better understanding of these conditions. The etiologies of overgrowth conditions are largely unknown. Although overgrowth conditions are highly variable, clinically, these patients present similarly with difficulty in walking, fitting in shoes, toenail irritation, and cosmetic concerns. Conservative treatment is often of limited long-term value. Surgical intervention must be approached on a case-specific basis with attention to multiple factors. Due to the rarity of these conditions, large studies are lacking and most of our knowledge and surgical recommendations are based off of case studies. In this update, we will review these conditions and clarify the differences among them. We present a patient with an overgrowth condition of the first ray and describe the surgical correction that yielded a successful outcome.