case_images: PMC5648087_01
case_images: Bilateral fifth toes polydactyly. A rudimentary supernumerary toe is observed in the left foot. In the right foot, the medial fifth toe is deviated downward and medially underneath the fourth ray.
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case_images: On the left foot, a hypoplastic lateral supernumerary toe with cutaneous irritation was observed (Figure 1).
case_images: Feet X-rays demonstrating bilateral duplication of the proximal phalanges of both fifth rays, compatible with the clinical diagnosis. The left supernumerary toe is clearly hypoplastic.
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case_images: The left supernumerary toe was clearly hypoplastic (Figure 2).
case_images: An ulcerated lesion under the first two phalanges of the fourth and over the distal phalanges of the medial fifth toe was observed.
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case_images: Ulcers observed under the first two phalanges of the fourth and medial fifth toe (Figure 3) prompted excision of the medial duplicated toe.
case_images: Complete excision of the fifth medial toe followed by exostectomy of the fifth metatarsal medial head. The plantar plate reconstruction was performed by drilling two holes running from the dorsal cortex of the proximal phalanx. Thereafter, 2.5 FiberWire  was sutured to the plantar plate and recovered through the drill holes in the proximal phalanx.
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case_images: FiberWire  (Arthrex, Naples, FL, USA) was used to approximate the distal plantar plate to the proximal phalanx and then both sutures ends were recovered through the drill holes at the proximal phalanx (Figure 4). Finally, both suture ends that were tied over the dorsal phalangeal cortex managed to fix the plantar plate onto the base of the proximal phalanx, at the same time rotating the toe back into the desired anatomical position.
case_images: Final view after surgery.
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case_images: Wound closure was performed in a layered fashion (Figure 5).
case_images: Control X-rays showing adequate correction of the deformities.
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case_images: The follow-up X-rays were taken at 3 months after the surgery (Figure 6).
case_images: View at 18 months of follow-up.
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case_images: After 18 months of follow-up, the patient had no complaints, wore normal shoes and had good functional status (Figure 7).