28 
Split-Hand and Split-Foot Deformities 
The hands are curiously and variously misshapen and over the abnormal bony 
points thick masses of subcutaneous tissue are placed, which are frequently conica 
in appearance and as a rule situated towards the palmar aspect. These prominences 
are utilised in conjunction with the remaining finger or fingers for gripping. 
When a cross bone exists, the hand is far broader than might be expected from the 
number of metacarpals present. In no case is there any abnormality in the 
arrangement of the arteries as far as the wrist, and the tendons present correspond, 
so far as can be observed, to the presence of the metacarpals and phalanges to 
which they are normally attached. There are often contractures of the remaining 
fingers, so that they are flexed and drawn towards the middle of the hand. The 
contractures are dependent on the constitution and arrangement of the deeper 
structures and not upon the condition of the skin. 
Each foot consists of two toes separated by a deep cleft. In exceptional cases 
there may be more than one complete toe in that portion of the foot bounding the 
outer side of this cleft, as evidenced by a double toe nail and longitudinal 
furrowing of the skin, but they are in no case separate. The cleft is always deep, 
and may have a length of four inches. As a rule it is two and a half to three 
and a half inches in the adult foot. The toes are widely apart at their centres, 
but are generally bent claw-wise at their extremities*. This separation of the 
toes gives the foot an unusual breadth in spite of the absence of metatarsals, a 
breadth which may amount to eight inches, or more. As a rule the inner border of 
the cleft runs parallel to the inner border of the foot for the greater part of its 
course and ends in furrows on the dorsum and sole of the foot. The outer border 
of the cleft is moulded over the remains of the metatarsal bones when these are 
present and is in consequence more irregular. On account of the inbending of 
the toe extremities to the middle line the foot is usually shortened. The tendons 
of the foot are arranged, like those of the hand, in conformity with the underlying 
bones ; they are complete when the toes are present, and run to the ends of 
shortened digits. 
The functional capacity of both hands and feet is great. The affected persons 
perform work which requires skilful manipulation. The needlework of some of 
the females is good ; the handwriting of many is excellent. One individual is a 
boot-maker, two others drive cabs, none find difficulty in clothing themselves and 
most do so with extraordinary rapidity, even to the lacing of boots. The gait is 
normal ; the toes are often opposible, more especially in the young, and frequently 
with considerable power and also delicacy. It is said of one that he is able 
in this way to lift pins from the Hoor with his feet. Nothing is more astonishing 
than the accurate and coordinate manner in which most of the functions of the 
normal hands and feet are carried out by parts so grossly deformed f. As to 
* There is no evidence that this is produced by boot pressure, for it occurs in the younger subjects 
and has been observed in the new born. Tliere is every possibility of its having been acquired in iitero. 
t The majority of those reporting this deformity express their surprise at the mobility of the 
malformed extremities. 
