External section. The Buddha had enormous height, membranes between his fingers and toes, and a retractable penis.

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Syndactyly – abnormal development of fingers due to a violation of their separation in the embryonic stage. The disorder accounts for about 50% of all congenital hand lesions and occurs with an incidence of 1:2000.

It can be an independent disorder or accompanied by other lesions: polyphalanxia and underdevelopment of fingers, brachydactyly, cleft hand, etc. 60% of children with this disorder have an additional anomaly of the musculoskeletal system.

Causes of pathology

The reasons why syndactyly of the toes and hands occur lie in the field of genetics. More than 20% of severe forms have genetic character.

In the absence of this factor, it is necessary to assume a violation of the separation of the fetal limbs under the influence of negative conditions. The laying of the hand occurs at the 5th week of development; At this stage, the fetus exhibits natural syndactyly.

With standard development, fingers begin to develop at 8 weeks. If the formation of septa is disrupted, the fingers do not separate, i.e., syndactyly appears.

Among the causes of pathology may be harmful effects on the expectant mother, x-rays, and infections during pregnancy. Often the reasons for the appearance of such a baby are unknown.

The initial factors of pathology should be sought in the composition of gene and chromosomal abnormalities.

Less commonly, acquired damage occurs due to burns of the hand.

Another genetic disease of the limbs - causes and treatment options for the pathology.

How effective is treatment of osteomyelitis with antibiotics in combination with other methods? You can find out more about the treatment of the disease in our material.

Classification of the disease

In medicine, deviation is divided by type, length of connection and condition of the fingers.

By type of adhesions:

soft tissue appearance;
bony appearance.

The photo shows syndactyly in full form

According to the length, depending on the number of fused parts of the fingers, they are distinguished full and incomplete forms. Complete - fusion covering the nail parts. Incomplete - fusion of the joints of the phalanges. This form is divided into incomplete basal form and terminal form.

Depending on the state of the connected fingers, the deviation can be simple or complex. In a simple disorder, normal fingers are connected; in a complex disorder, abnormal fingers are connected. Among other things, there are hereditary types of the disease:

Type I - membranous connection of the 3rd and 4th fingers; 2nd and 3rd toes. There are membranes between other fingers.
Type II - connection of 3 and 4 fingers with doubling of 4 fingers, connection of 4 and 5 toes with doubling of 5 fingers.
Type III – bilateral connection of the 4th and 5th fingers; The little finger is shortened. Basically, the feet are not affected.
Type IV – bilateral skin lesions, spoon-shaped hand. No damage to the feet is observed.
Type V is a lesion involving the union of the metacarpal and metatarsal bones. On the hands there is a skin connection of 3-4 fingers, on the feet there are 2-3 fingers.

Unilateral deviation is observed more often than bilateral; connecting the fingers more often than the toes.

Clinical picture of the pathology

When the hands are affected, the middle and ring fingers join together; toes -2 and 3 toes. The ring and little fingers, the thumb and index fingers, and all fingers are rarely connected. With bilateral damage, the connection is symmetrical.

Undivided fingers may be normal or underdeveloped. Sometimes there is a decrease in the number of phalanges.

With a basal lesion, the performance of the hand is almost not affected. But syndactyly in children slows down general development child.

Due to the limitation or inability to carry out various movements of the fingers, the child’s mental, speech and mental development suffers. Underdevelopment of the hand complicates studies and limits the choice of profession.

Diagnostic techniques

The disorder is determined immediately after the baby is born by a neonatologist. Subsequent examination and observation is carried out by a pediatric surgeon or orthopedist. To exclude hereditary problems, a child with a disorder should be consulted by a geneticist.

The diagnosis can be made during a visual examination, but research is necessary to determine the type and develop a treatment algorithm.

X-ray of hands and feet Helps evaluate joints, bone density, presence and length of bone joints. To determine the subtleties of the structure of blood vessels in connected parts, it is carried out rheovasography, ultrasound, angiography, electrothermometry.

Treatment of the disease

Treatment of finger syndactyly is carried out only by surgery. If a diagnosis of syndactyly of the toes is made, then surgery is not prescribed if the disorder does not interfere with walking.

Deadlines and suitable way The procedure is selected based on the shape and nature of the lesion.

The purpose of the intervention is to eliminate the external defect and restore hand function.

The optimal age for the procedure is 4-5 years. With terminal lesions, earlier surgery is necessary to help prevent uneven growth and secondary changes in the fingers.

Treatment approaches are divided into groups:

After surgery, a cast is applied to the limb to immobilize the fingers for 4 months.

14 days after the intervention, treatment begins, consisting of massage, exercise therapy, ultraphonophoresis, mud and ozokerite applications.

Prognosis and complications

The methods of treatment used give positive results. With timely surgery, the structure and function of the hand are restored.

Indicators of the effectiveness of treatment are the absence of deformation and tightening scars, full range of motion in the interphalangeal joints, and good sensitivity of the fingers.

If left untreated, the deviation negatively affects the growth and development of the limb.

Webbing between the toes and the sixth finger on the hand are given by nature, but are unnecessary for [human] properties. Tumors and goiters grow on the [human] body, but for the natural [they] are unnecessary. Mercy and justice in many prescriptions are distributed among [all] five internal organs. However, they do not correspond to the truth of natural properties. Just as the webs between the toes are additional useless meat, and the sixth finger of the hand is an additional useless finger, so many external things are [like] the webs and sixth fingers for the properties of [all] five internal organs. Excessive mercy and justice [cause] many instructions on how to listen and watch.

Therefore, excessively acute vision [leads to] a mixture of [all] five colors, to sophistication in ornamentation, to dazzling with dark and yellow embroidered royal clothes. Wasn’t it the same with [Seer of the Web] from afar? An overly sensitive ear [leads to] a mixture of five sounds, to sophistication in six tones, [a predilection for musical instruments made of] metal and stone, silk and bamboo, bells and six semitones. Isn't that what Master Kuan did? ? Excessive mercy [leads to] the rejection of properties, to the constraint of [human] nature in the name of glory, to the fact that everyone in the Celestial Empire blows flutes and beats drums, glorifying an unattainable model. Isn’t that what Zeng[zi] and Chronicler [Yu] did? {1}

Excess in disputes [leads to] a heaping of phrases, [like] tiles or knots on a rope, to a delight in identity and difference, hardness and whiteness, unrestrained useless words for the sake of momentary glory. Isn't that what Yang [Zhu] did? {2} and Mo [Di]?

All these teachings with membranes and sixth fingers do not constitute the true truth in the Celestial Empire. The real truth is not to lose the natural properties. Consequently, when uniting, the membranes are destroyed, and when dividing, the extra fingers are destroyed. [However] long should not be considered excessive, and short should not be considered insufficient. Although a duck's legs are short, [but] try to stretch them, you will cause pain; although the crane’s legs are long, [but] cut them off and you will cause grief. If you don’t cut off what is naturally long, don’t lengthen what is naturally short, you won’t need to eliminate the pain. Oh, how contrary to human nature are mercy and justice! How much pain mercy causes people!

The one who has the membrane between his fingers cut will cry; the one whose extra finger is bitten off will scream. One has an excess, the other has a deficiency, and both have the same pain. Modern merciful people with clogged eyes are sad about the troubles of the world, and the unmerciful, violating natural properties, hunger for wealth and honors. Oh, how contrary to human nature are mercy and justice! How much noise they have caused in the world since the times of the Three Dynasties! {3} .

He who, with the help of a hook and a plumb line, a compass and a square, gives [things] their proper [shape], mutilates their nature; the one who strengthens [things] with ropes and knots, glue and varnish harms [their] properties. The one who [forces people] to bend in rituals and dances, to protect mercy and justice in order to bring peace to the minds of the Celestial Empire, deprives them of permanent [properties] {4} . [All things] in the Celestial Empire have permanent [properties]. What is permanent is that which is crooked without a hook, straightened without a plumb line, rounded without a compass, squared without a square; what came together without glue or varnish, came together without rope or braid. So [everyone] in the Celestial Empire, captivating one another, is born and does not know why they are born; they gain in the same way and do not know why they gain. This order existed both in ancient times and in our time; [it] cannot be violated. How can one bound by mercy and justice, like glue and varnish, rope and braid, enjoy natural properties? [They] are misleading the whole world. A slight misconception changed direction; the great error was changing [human] nature. How is this known? Since the [Fencer] from the clan of the Tiger Wielders confused the Celestial Empire with his call for mercy and justice, everyone, under duress, hastened to follow mercy and justice. Has not human nature changed due to [the appearance of] mercy and justice?

Let's try to [express] a judgment about this.

Since the time of the Three Dynasties, every [person] in the Celestial Empire has changed [his] nature because of things. Insignificant people sacrificed their lives for the sake of profit, men - for the sake of glory, military leaders - for the sake of the family, wise men - for the sake of the kingdom. These people have different occupations, different nicknames, but by sacrificing themselves, they caused the same harm to their nature.

So, the Slave and the Slave were tending a flock together and both lost their sheep. They asked Rab what [he] was doing? It turned out that he was reading a tablet with a fortune-telling record. They asked the Slave what [she] was doing? It turned out that she was playing dice. They were engaged in different activities, but both lost sheep in the same way. Thus, the Elder Equal, thirsting for glory, died at the foot of the First Sun Mountain; robber Zhi {5} , thirsty for profit, died on the top of the Eastern Kurgan. Their death was caused by different reasons, but both of them equally shortened their lives and caused harm to their nature. Why should Elder Equal be praised and Zhi blamed?

Of those who sacrifice themselves in the Celestial Empire, some do it for the sake of mercy and justice, then they are usually called noble men; others - for the sake of property and wealth, then they are usually called insignificant people. They sacrifice themselves equally, why do they become noble or insignificant? Robber Zhi also shortened his life and damaged his nature, like the Elder Equal, where did the difference between them [come from], like [the difference] between the insignificant and the noble?

[The ability] to subordinate one’s nature to mercy and justice, even [as] perfect as that of Zeng [zi] and Chronicler [Yu], I do not call a treasure; [the ability] to subordinate one's nature to [all] five tastes, even [as] perfect as Yu'er's {6} , I don't call it a treasure; those who subordinate their nature to [all] five sounds, even [as] completely as Master Kuan, I do not call sensitive; I do not call those who subordinate their nature to [all] five colors even [as] completely as the [Seer] of the Web from afar, keen-sighted. I call the possession not of mercy and justice, but only of its properties, a treasure. . I do not call the possession of mercy and justice a treasure, but only the giving of freedom to one's natural feelings. I do not call the one who hears others sensitive, but only the one who hears himself. I do not call the one who sees others keen-sighted, but only the one who sees himself. After all, he looks at others who does not see himself; he who does not control himself takes possession of others; he takes possession of what belongs to others, and not what he himself has acquired; he strives for what is suitable for another, and not for what is suitable for himself. After all, those who strive for what is suitable for another do not strive for what is suitable for themselves. They are equally vicious, even if it is the Elder Equal or the robber Zhi! I am ashamed of natural properties, so I do not dare to practice mercy and justice with the former and do not dare to indulge in vices and the latter.

!!! Chapter 9

THE HORSE HAS HOOFS

The horse has hooves, and [he] can walk on frost and snow. The skin protects [him] from wind and cold. He nibbles grass, drinks water, rears up and gallops. This is the true nature of the horse. He doesn't need high towers or huge halls.

But the One Rejoicing in Mastery said:

- I know how to tame horses.

[And he began to] trim their manes, trim their hooves, began to scorch and brand them, bridle and hobble them, lock them in the stable and paddock. Out of [every] dozen, two or three horses died. [He] began to tame them with hunger and thirst, let them trot and gallop, and forced them to maintain formation. In front [they] were threatened by a bit and a harness, and from behind by a whip and whip. More than half of the horses died.

Potter said:

– I can sculpt from clay.

The circles [for him] corresponded to the compass, and the squares to the square.

The carpenter said:

– I know how to process wood.

Its curves corresponded to the hook, and its straight lines corresponded to the plumb line.

Do clay and wood, by their nature, tend to correspond to the compass and the square, the hook and the plumb line? But still [the masters] were glorified from generation to generation:

– He who rejoices in Mastery knew how to tame horses! The Potter and the Carpenter knew how to work with clay and wood!

This is the mistake of those who ruled the Celestial Empire.

I think that the master, ruling the Celestial Empire, would have acted differently. What is constant in the nature of people is that [they] weave and dress, cultivate the land and eat - this is called [their] common property. [They were once] united, not divided into groups, [and this I] call natural freedom {1} . Therefore, in times [when] the properties were real, they walked slowly and sedately, looked firmly and adamantly. At that time, roads and paths had not yet been laid in the mountains, there were no boats or bridges on the lakes; all the creatures lived together, and villages stretched one after another. Birds lived in flocks, animals walked in herds, grass grew in full splendor, and trees grew to their full length. Therefore, one could walk, leading a bird or animal, climb a tree and look into the nest of a magpie or crow. Yes, in times [when] properties were real, [people] lived next to birds and animals, [were one] kind with all creatures. Did they know about [the division into] noble and insignificant? [No one] equally had knowledge, [no one] violated their properties, [everyone] was equally free from passions, and this [I] call artlessness. In artlessness, the people found their nature.

When the sages appeared, they began to take [the ability to] walk around with a limp for mercy; [the ability] to walk on tiptoe - for justice - and [everything] in the Celestial Empire fell into confusion. Promiscuity and excess began to be mistaken for pleasure; Folded hands and bent knees began to be taken for rituals. And [everyone] in the Celestial Empire began to separate from each other.

Who could carve a sacrificial bowl without damaging the wood? Who could carve a scepter and a mace without damaging the white jade? How could we introduce mercy and justice without violating natural properties? How could they introduce rituals and music without throwing away natural feelings? Who [would] be able to create an ornament without confusing [all] five colors? Who would [make] five sounds, without confusing them, answer six pipes? It is the fault of the craftsmen that they mutilated the tree for the sake of the vessels; that for the sake of mercy and justice they violated natural properties, the fault of the sages {2} .

While the horses lived in the open air, they nibbled grass and drank water. Rejoicing, they intertwined their necks and caressed, getting angry, they turned their backs to each other and kicked. This was their only knowledge. But when they put a yoke on the horses and decorated their muzzles with the image of the moon, they learned to squint and arch their necks, resist and kick, break the yoke and tear the reins. Therefore, it is the one who rejoices in Mastery who is to blame for the fact that the horses have acquired [such] knowledge and learned the habits of robbers.

During the time of the generation of Fiery Helpers {3} the people lived without knowing what [to] do; walked around not knowing where. [The man] stuffed his mouth and was happy, patted himself on the stomach and went for a walk. This was all his ability. But when the sages appeared, they [introduced] bowing and prostration, rituals and music to correct the form [behavior] in the Celestial Empire; They hung mercy and justice for [common] joy in order to bring peace to the minds of the Celestial Empire. And then the people began to walk around with a limp, and became so addicted to knowledge and to competition in the pursuit of profit that they could not be stopped. This is also the fault of the wise men.

!!!Chapter 10

HACKING CHESTS

To protect yourself from thieves who break open chests, rummage through bags and open cabinets, you need to tie [everything] with ropes, lock it with bolts and locks. This is smart, they usually say. But the big Thief comes, grabs the entire chest under his arm, throws the cabinet on his back, hangs the bags on the yoke and runs away, fearing only one thing - so that the ropes and locks [are] weak. Then those who were previously called smart, it turns out, were only collecting goods for the big Thief. Let's see if the one who is usually called smart is collecting goods for big thieves? Is not the great robber guarded by the one who is called the sage? How to prove that this is true?

In the old days, in the kingdom of Qi, neighbors from [different] communities saw each other, roosters called to each other there, dogs answered each other [barking {1} . In space] more than two thousand square whether They set up nets and cultivated the land with a plow and hoe. Within the four borders, they followed the example of the sages in everything when building the temple of ancestors, the altar of the Earth and Millet, houses, when dividing them into neighborhoods, villages, districts and regions.

But then one morning Tian Chengzi killed the Qis king and stole his kingdom. Did he just steal the kingdom? [No!] Along with the kingdom, he stole wise orders. And although Tian Chengzi gained fame as a thief and robber, he himself enjoyed the same peace as the Highest and the Protector. Small kingdoms did not dare to reproach him, and large ones did not dare to punish him. And so twelve generations [of his descendants] ruled the kingdom of Qi.

If he stole not only the kingdom of Qi, but also its orders [introduced] by the smart and sages, then aren’t these same [smart and sages] the guardians of thieves and robbers? {2}

Let's see if those who are called the smartest in the world are not collecting [goods] for big thieves? Are not robbers protected by those who are called the wisest? How to prove that this is true?

[Here] in the old days they beheaded the Dragon Met, cut out the heart of the Shield Prince, gutted Chang Hong {3} , Zixu's [body] rotted in the river {4} . All four are worthy people, but they could not avoid execution.

The robber Zhi's accomplice asked him:

– Do robbers have their own teaching?

– Is it possible to go [fishing] without training? - Zhi replied. – To guess from false [rumors] that there are treasures in the house is wisdom; to enter [it] first is courage; to be the last to leave is justice; to sniff out whether [robbery] is possible - knowledge; to divide [the booty] equally is mercy. Without these five [virtues], no one in the Celestial Empire can become a major robber. From this it is clear that if without the teachings of the sages one cannot become a good person, then without the teachings of the sages one cannot become a robber. {5} . But there are few good people in the Celestial Empire, and many unkind ones. Therefore, the benefit that the sages bring to the Celestial Empire is small, but the harm is great. That’s why they say: “If you cut your lips, your teeth get cold,” “because of bad wine in Lu, Handan was under siege.” {6} “When a sage is born, a great robber also appears.”

If the wise men are driven away and the robbers are left alone, order will reign in the Celestial Empire. After all, [if] the stream dries up, the valley will also be deserted; [if] you raze a mountain to the ground, the abyss will be filled. When the wise men die, the great robbers also disappear, peace will come in the Celestial Empire and there will be no more trouble. Until the wise men die, the great robbers will not die either. To rule the Celestial Empire by respecting the sages means to respect the benefit of the robber Zhi.

If they make measures and garnets to measure, they will steal [the grain] along with the measures and garnets; if they make weights and steelyards for weighing, they will steal [and what is being weighed] along with the weights and steelyards; if they make credentials and royal seals to ensure trust, they will steal [the kingdom] along with the credentials and royal seal; if they create mercy and justice for the correction of [morals], then they will steal [the correction of morals], along with mercy and justice. How to prove that this is true?

[Here:] who stole the hook - to the chopping block, who stole the throne - to the kingdom {7} . At the gates of rulers mercy and justice are kept. Isn't this theft of mercy and justice, wisdom and knowledge? That is why, following the great robbers, they steal kingdoms, steal mercy and justice, along with all the profit from measures and garnets, weights and steelyards, credentials and royal seals. [This] cannot be stopped, even by rewarding a dignitary with a chariot and a hat; [this] cannot be prohibited even by fear of an ax and ax; this cannot be curbed out of respect for the profit of the robber Zhi - such is the fault of the sages. That’s why it is said: “Fish cannot leave the depths, the instrument of profit in the country cannot be shown to people.” {8} . The sages are the instrument of profit in the country, [they] should not show themselves to people. Therefore [should]: destroy wisdom and discard knowledge, then the great robbers will also disappear; throw away the jade and split the pearls, then the small thieves will disappear; burn the credentials and break the royal seals, then the people will become simple and artless; break the measures and interrupt the steelyards, then the litigation among the people will cease; destroy all the rules of the sages in the Celestial Empire, then it will be possible to reason with the people; mix [all] six pipes, burn the pipes and harp, stop the ears of the blind Kuan, and everyone in the Celestial Empire will gain hearing; destroy the ornaments, scatter [all] five colors, glue the eyelids of the [Seer] Web from Afar, and everyone in the Celestial Empire will gain sight; destroy the hooks and plumb lines, throw away the compasses and squares, break the fingers of the Skillful Hammer {9} , and everyone in the Celestial Empire will gain mastery. That is why it is said: “The greatest art is like inability.” {10} . [One should] despise the behavior of Zeng [Zi] and Chronicler [Yu], muzzle Yang [Zhu] and Mo [Di], drive out mercy and justice, and the properties of everyone in the Celestial Empire will be equal to the original ones. [If] everyone gained sight, no one in the Celestial Empire would be blinded; [if] everyone gained hearing, no one in the Celestial Empire would be deafened; [if] everyone acquired knowledge, there would be no errors in the Celestial Empire; [if] everyone acquired their own properties, there would be no vice in the Celestial Empire. Such as Zeng [zi] and Chronicler [Yu], Yang [Zhu] and Mo [Di], Master Kuan, Skillful Hammer and [Seer] of the Web From afar flaunt their virtues in order to blind [everyone] in the Celestial Empire. You can't imitate them.

Don't you know about the time of true properties? In ancient times there lived [people] from the Yongcheng clans {11} , Huge Courts, Uncle Lord, Middle, Plain of Chestnuts, Breeders of Black Horses, Creators of Chariots, Flame Helpers, Sacred Cup and Brazier, Causing Flames, Preparing Sacrificial Meat, Sacred Tillers. In those days, “people remembered by tying knots on ropes” {12} , enjoyed chewing his food, admired his clothes, was happy with his customs, contented with his home. “Inhabitants of neighboring kingdoms saw each other, roosters called to each other, dogs answered each other [by barking]. People lived to a ripe old age, but did not communicate with each other.” In those days, true order reigned.

And now it has reached the point where people, craning their necks and standing on tiptoes, say [to each other]: “A wise man has appeared there.”

And, taking provisions with them, they rush to him, leaving the houses of their parents, abandoning the affairs of the sovereign. [Their] tracks lead across the borders of kingdoms, the ruts laid by [their] carts stretch through thousands whether. This is the fault of the higher ones, who are addicted to knowledge. When the higher ones, not possessing teaching, truly become addicted to knowledge, [they] plunge the Celestial Empire into great turmoil.

How to prove that this is true? [But if] knowledge [about] bows and crossbows, snares, arrows on a cord and [other] weapons increases, then the birds in the sky become confused; [if] knowledge grows [in the field of] hooks and baits, nets and snares, nets and bamboo nets, then the fish in the water become confused; [if] knowledge [about] pens, traps and snares grows, then the animals in the swamps become confused. [When] the ability to dissemble and dodge, to harass and defame, [to establish] identity and difference, hardness and whiteness grows, then morals are thrown into confusion by sophistry. Therefore, great turmoil arises in the Celestial Empire every time and the blame for it falls on those who are partial to knowledge {13} .

Therefore, everyone in the Celestial Empire knows how to strive for knowledge of the unknown, but does not know how to strive for knowledge of the known; everyone knows how to condemn what is considered unkind, but does not know how to condemn what is considered good - this leads to great confusion. That is why the light of the sun and moon is eclipsed above, and the power of the mountains and rivers is exhausted below; the gifts of the four seasons are diminishing. [Everything down to] weak worms and small insects lose their nature. How terrible is the turmoil in the Celestial Empire due to the addiction to knowledge! And so it has been since the times of the three dynasties. They forgot the simple, modest people and rejoiced at the cunning, resourceful talkers; They left the peace and quiet of inaction and rejoiced at the empty verbosity. It was this empty verbosity that plunged the Celestial Empire into confusion!

!!! - Chapter 11

LEAVE [EVERYONE] TO THEMSELVES

They heard that the Celestial Empire should be left to its own devices, but they did not hear that order should be restored in the Celestial Empire. “Grant” - out of fear that the nature of the Celestial Empire would not be distorted, “each to himself” out of fear that [human] properties would not change. [If] the nature of the Celestial Empire does not become distorted, and [human] properties do not change, will it be necessary to restore order in it?

In the old days, the Most High began to restore order so that the Celestial Empire would rejoice, people would rejoice in their nature, and [they] would lose peace. The One tearing it apart began to restore order so that the Celestial Empire would be sad, people would mourn their nature, and [they] would be deprived of joy. But [life] without peace, without joy is not a human characteristic. Is it possible to survive for a long time without [inherent human] properties? [No!] This has never happened in the Middle Kingdom .

When a person is overjoyed, the [power] of heat is consumed in excess; when anger is excessive, the [power] of cold is spent in excess. When there is excessive consumption of both heat and cold, the four seasons of the year cease to alternate [correctly], the harmony of coolness and warmth is disrupted, and [these disturbances] cause harm to the human body. He ceases to [distinguish] when to be happy and when to be angry, his life is deprived of constancy, his thoughts are deprived of satisfaction, his work stops halfway. This is where arrogance and disfavor, superiority and oppression arise in the Celestial Empire, and behind them appear the robber Zhi, Zeng [zi] and the Chronicler [Yu. If] throughout the entire Celestial Empire we reward for good, [this] cannot be dealt with; [if] all over the Celestial Empire one punishes for evil, [it] cannot be dealt with. For the Celestial Empire is great, [for everyone] there are not enough rewards and punishments {1} .

Since the Three Dynasties, everyone has been making noise about rewards and punishments. Where will the leisure come from to [find] peace in natural properties? And besides, enjoying their keen eyesight, they indulge in excess in flowers; enjoying their fine hearing, they indulge in excess in sounds; enjoying mercy, they violate [natural] properties; enjoying justice, they violate the laws of nature; enjoying rituals, they help perversions; enjoying music, they help debauchery; enjoying wisdom, they help artificiality; enjoying knowledge, they help vices.[If everyone] in the Celestial Empire [found] peace in natural properties, these eight [pleasures] could remain, or they could disappear.[But when] in the Celestial Empire they do not [find] peace in natural properties, because of these eight [pleasures] people begin to cut [each other] into pieces and twist [into a ball], push and take away and plunge the Celestial Empire into turmoil. [If] in the Celestial Empire they begin to honor pleasures and yearn for them, how strong [this] delusion becomes! Will they [be able] to pass by [pleasures] and refuse them? After all, in order to talk about them they fast, in order to indulge in them they kneel, in order to portray them they play and sing. What can you do?

Therefore, for a noble man, [if he] is forced to ascend the throne, inaction is best. Inaction, and behind it - peace in natural properties. For the one who values his life more than the kingdom can be entrusted with the Celestial Empire; the one who loves his life more than the kingdom can be entrusted with the Celestial Empire. If the sovereign is able not to dissipate his inner self, not to reveal sight and hearing, to rise [like] a Dead Man, [then] he will look [like] a Dragon; will plunge into silence, and his voice will thunder like thunder; nature will obey the movement of [his] thoughts. [He will indulge in] serenity and inaction, and [will find himself] connected with [all] the darkness of beings. Does such a person have the leisure to restore order in the Celestial Empire?

Tall Timid {2} Laozi asked:

– [If] we don’t restore order in the Celestial Empire, how can we fix people’s hearts?

- Be careful! - Laozi answered him. – Don’t disturb the human heart! As soon as it is overthrown, a person will humiliate himself; as soon as it is elevated, a person will become proud. So he turns either into a slave or into a murderer. The heart can be tender and weak - and then it cannot cope with the strong and strong; it can be as hard as a chisel and cut a precious stone. It will either flare up like a flame, or become cold as ice. It changes with amazing speed, manages to visit all four seas twice before the contemptuous look is replaced by a benevolent one.

At rest, it will not tremble, like an abyss; when in motion, it will rush to the heavens. It is willful, proud, and cannot be curbed. This is what the human heart is like!

In the old days, the Yellow Ancestor alarmed hearts with mercy and justice. And the Highest and Protector, in order to educate [everyone] in the Celestial Empire, [worked so hard that the hairs on their shins were worn away {3} and fluff on the thighs. [They] tore [all] their five internal organs for the sake of mercy and justice, gave blood and breath to establish laws and order, and yet they failed. And then the Tallest exiled [the people] with the Horse on Shishak to the Revered Mountain, moved the Three Miaos to [Mountain] Tri-Headed, expelled the Master of the Spills {4} to the Abode of Darkness. [But] this did not cope with the Celestial Empire.

When the [time] of the kings of the three [dynasties] came, the Celestial Empire was seized with horror. The despised appeared: the Tearer and the robber Zhi; revered ones appeared: Zeng [zi] and Chronicler [Yu], and Confucians and coins also appeared. And then they began to suspect each other both in joy and in anger, to deceive each other, both smart and stupid, to blame each other, both good and unkind, to ridicule each other, both false and truthful, and the Celestial Empire began to decline. Differences appeared in properties, and decay and decay set in in [human] nature. In the Celestial Empire they became addicted to knowledge, and in search of [knowledge] all the people went to extremes. And then they used axes and saws, began to execute according to the [carpenter’s] plumb line and rule, to sentence with a chisel and an awl, they plunged the Celestial Empire into terrible turmoil, and crimes began to disturb people’s hearts. That is why the worthy ones hid under the cliffs of the great mountains, and the sovereigns who owned the darkness of chariots trembled with fear in the temples of their ancestors.

Nowadays the beheaded lie on top of each other, shackled in neck and leg stocks, pushing against each other, the condemned await their turn at the scaffold. And among those handcuffed and in stocks, Confucians and Mohists began to appear, walking on tiptoe, waving their arms. Oh God! Oh shame! O shamelessness! And we had no idea that their wisdom, their knowledge served as handcuffs and stocks; their mercy, their justice serve the chisel and the collar {5} . Who knows if Zeng [zi] and Chronicler [Yu] were not a rattling arrow for the Tearing One and the robber Zhi? That is why it is said: “Forget about wisdom, discard knowledge, and the Celestial Empire will find peace.”

[For] nineteen years the Yellow Ancestor stood [on the throne] as the Son of Heaven; [his] orders were carried out [throughout] the Celestial Empire. [One day he] heard that on the top of the [Mountain] of the Unity of the Void resides the All-Encompassing Perfect {6} , and went to see him.

“I heard,” said the Yellow Ancestor, “that [you], my teacher, have comprehended the true path.” Let me ask a question, [what] is its essence? I strive to use the essence of heaven and earth to help [the ripening of all] five grains to feed the people. I also strive to direct [the forces of] heat and cold for the benefit of all living things.

– What you want to ask about is the essence of things; and the way you want to control is detrimental to things,” answered the All-Encompassing Perfect One. - Since you rule the Celestial Empire, it rains before the vapors turn into clouds; leaves and grass fall off before they turn yellow; The rays of the sun and moon are fading more and more. In your heart there is [a penchant for] trifles, [like] an eloquent one. Are you worthy of a conversation about the true path?

The Yellow Ancestor retired, relinquished [government] of the Celestial Empire, and built himself a separate hut with a mat of white wheatgrass. [Here he] spent three moons in idleness, and then visited the teacher again.

The Comprehensive Perfect lay with its head to the south. Full of humility, the Yellow Ancestor crawled [to him] on his knees, twice, bowed to the ground and asked:

“I heard that [you], my teacher, have comprehended the true path. Let me ask you a question: how to manage yourself, how to achieve longevity?

The All-Encompassing Perfect One hurriedly stood up and replied:

– You asked a great question! Come, I will tell you about the true path.

The smallest of the true path is deep and dark, the greatest of the true path is gloomy and silent. Don’t look, don’t listen, rest, keeping [your] mind, and the body will straighten itself out. Be calm, clean, do not bother your body, do not disturb your seed and you will live long. [If] the eyes have nothing to see, the ears have nothing to hear, the heart has nothing to know, your soul will preserve [your] body, and the body will live a long time. The more knowledge you have, the sooner you will fail. Take care of your inner self, shut yourself off from the outer.

And then I will rise with you to great clarity right up to the drains of the highest [power] heat; I will enter the gates of darkness, and [we] will reach the sources of the highest [power] of cold. Heaven knows its own, earth knows its own; [each of the forces] heat and cold has its own container. Take care and preserve yourself, and things will ripen on their own. I keep [the forces of heat and cold] in unity in order to keep them in harmony, therefore I have preserved myself for one thousand two hundred years, and my body [is still] not decrepit.

Yellow Ancestor bowed to the ground twice and asked:

– Tell us about nature, Comprehensive Perfect One.

“Come, I’ll tell you,” answered the All-Encompassing Perfect One. “She is inexhaustible in her things, but all people think that [she] is finite.” She is immeasurable in her things, and all people think that [she] is ultimate. Of those who found my way, the best became ancestors, and the worst became kings. Of those who lost my way, the best saw the light, and the worst turned to the earth. After all, everything that now flourishes was born from the earth and will return to the earth, so I will leave you and go through the gates of infinity to wander in boundless spaces. I will merge with the rays of the sun and the moon, I will unite in eternity with heaven and earth. When I leave, [even] those who are far from me will be sad. All people will die and only I will exist.

Supported by the vortex, Commander of the Clouds {7} wandered in the east and met with the Beginning Chaos. Beginningless Chaos walked around, hopping like a bird and patting his thighs. Seeing him, the Commander of the Clouds stopped in embarrassment and respectfully asked:

- Who [are you], old man? What are you doing, old man?

“I’m taking a walk,” Beginningless Chaos answered him, continuing to pat himself and jump.

“I want to ask a question,” said the Commander of the Clouds.

- Ugh! – Having looked [at him], Beginningless Chaos exclaimed.

“There is no harmony in the ether of the sky,” began the Commander of the Clouds, “there is stagnation in the ether of the earth, there is no agreement in the six phenomena [of nature], there is no order in the change of seasons.” What [should I] do [if] I am now going to harmonize the essence of the six phenomena in order to feed all living things?

“I don’t know, I don’t know,” answered Beginningless Chaos, patting himself, jumping and shaking his head.

Warlord Clouds did not dare to ask [again].

Three years have passed. Wandering in the East, the Commander of the Clouds passed the plain of the Dwellers. [He] again noticed the Beginningless Chaos, in great joy hurried [to him] and spoke:

- [You] haven’t forgotten me, [Equal] to Heaven? [Have you] not forgotten me, [Equal] to Heaven? – bowed to the ground twice and was about to ask him a question, when Beginningless Chaos said:

– What can I know? I float without knowing why. I'm rushing, not knowing where. The wanderer takes the trouble to watch [how everything goes] his way.

– I myself also believe that I am rushing [not knowing where]. But people follow me everywhere, and I can’t do anything about them. Now, imitating people, I want to hear [at least] one word from you.

And then Beginningless Chaos spoke:

– That the foundation of nature is shaken, the character of [all] things is perverted, the original nature remains incomplete, herds scatter, birds sing at night, drought burns trees and grass, trouble overtakes even reptiles and insects - the fault of those who restore order among people.

- But what should I do? – asked the Commander of the Clouds.

- Ah! [All this is one] harm! - exclaimed Beginningless Chaos, - return to yourself little by little.

– It’s so difficult to meet [you, Equal] to Heaven. “I would like to hear [at least] one more word,” asked the Commander of the Clouds.

- Ah! – answered Beginning Chaos. – Strengthen your heart. [If] only you surrender to non-action, things will develop of their own accord. Leave your body, your form, give up your sight, your hearing, forget about human orders, about things, merge in great unity with the self-existent ether. Free your heart and mind, become calm, like an inanimate [body, and then] each of the darkness of beings [becomes] himself, each returns to his root. Everyone will return to their root unconsciously, mixing in the general chaos, and will not leave [it] until the end of their lives. If they realize this, then<корень>abandoned. Don’t ask for its name, don’t ask for its properties, and [all] things will be born by themselves.

“Now I have found what I was looking for,” said the Commander of the Clouds. “[You, Equal] to Heaven, sent down your properties to me, enlightened me with silence,” he bowed to the ground twice, said goodbye and left.

The average person likes it when others are like him and does not like it when others are different from him. Love for one's own kind and dislike for those who are different come from the desire to stand out from the crowd. But is someone who strives to stand out from the crowd [really] outstanding? To calm down, [he] follows the crowd, [but his] experience is far from the skill [possessed] of the crowd. Anyone who wants to become a ruler collects what is useful from the kings of three dynasties, but does not notice what is harmful from them. For such a kingdom, the [fate] will depend on chance, and rarely, only by a lucky chance, the kingdom does not perish. There is not one [chance] in ten thousand that [such a] kingdom will exist. The death of [such a] kingdom [is indicated by the fact that] not a single [case there] will be completed, and tens of thousands [of cases] will be upset. Alas! Those who own the lands do not know [this]. The owner of the lands owns a huge thing. The one who owns a huge thing is not able to provide the things [themselves], and the one who does not [own] the thing is capable. He who understands how to [give] things [to] things rejects things. Does [he] only rule the people? [No!] He enters [all] six countries of the world, leaves them, wanders through [all] nine regions [of the earth]. He goes alone, he returns alone. This one is called the only one. Therefore, the only person is considered truly valuable.

The teaching of a great man is like a shadow cast by a body, an echo responding to a voice. [He] answers [every] question, exhausting his whole heart, uniting with [everything] in the Celestial Empire. Silent at rest, not limited in movement. Leads everyone as he wants, and returns [everyone] to himself. It wanders, leaving no traces, comes and goes without deviation, without beginning, like the sun. Let us also say that the body is fused with great unity. Great

Webbing between the toes and the sixth finger on the hand are given by nature, but for /human/ properties they are unnecessary. Tumors and goiters grow on the human body, but for the natural they are unnecessary. "Mercy" and "justice" in many prescriptions are distributed among /all/ five internal organs. However, they do not correspond to the truth of natural properties. Just as the membranes between the toes are additional useless meat, and the sixth finger of the hand is an additional useless finger, so many external things are /like/ the membranes and sixth fingers for the properties of /all/ the five internal organs. Excessive “mercy” and “justice” /cause/ many instructions on how to listen and watch.
Therefore, excessively acute vision /leads to/ a mixture of all five colors, to sophistication in ornamentation, and blinding by dark and yellow embroidered royal clothes. Wasn’t it so with “/The One Who Sees/ the Web from a Distance?” An excessively subtle hearing /leads to/ a mixture of five sounds, to sophistication in six tones, /to a predilection for musical instruments made of/ metal and stone, silk and bamboo, bells and six semitones. Isn't that what Master Kuan did? Excessive “mercy” /leads/ to the rejection of properties, to the constraint of /human/ nature in the name of glory, to the fact that everyone in the Celestial Empire blows flutes and beats drums, glorifying an unattainable model. Isn’t that what Zeng/-tzu/ and Chronicler /Yu/ did? /.../

All these teachings with membranes and sixth fingers do not constitute the true truth in the Celestial Empire. The real truth is not to lose the natural properties. /.../ /However/ long should not be considered excessive, and short should not be considered insufficient. Although a duck's legs are short, /but/ try to stretch them - you will cause pain; although the crane's legs are long, cut them off and you will cause grief. If you don’t cut off what is naturally long, don’t lengthen what is naturally short, you won’t need to eliminate the pain. Oh, how contrary to human nature are “mercy” and “justice”! How much pain “mercy” causes people!
The one who has the membrane between his fingers cut will cry; the one whose extra finger is bitten off will scream. One has an excess, the other has a deficiency, and both have the same pain. Modern “merciful” with clogged eyes are sad about the troubles of the world, and the unmerciful, violating natural properties, hunger for wealth and honors. Oh, how contrary to human nature are “mercy” and “justice”! How much noise they have caused in the world since the time of the Three Dynasties!
He who, with the help of a hook and a plumb line, a compass and a square, gives /things/ the proper /form/, cripples their nature; the one who strengthens /things/ with the help of ropes and knots, glue and varnish, harms /their/ properties. The one who /forces people/ to bend in rituals and dances, to protect “mercy” and “justice” in order to bring peace to the minds of the Celestial Empire, deprives them of their permanent /properties/. /all things/ in the Celestial Empire have permanent /properties/. What is permanent is that which is crooked without a hook, straightened without a plumb line, rounded without a compass, squared without a square; what came together without glue or varnish, came together without rope or braid. So /everyone/ in the Celestial Empire, enthralling one another, are born and do not know why they are born; they gain in the same way and do not know why they gain. This order existed both in ancient times and in our time, /it/ cannot be violated. How can one bound by “mercy” and “justice,” like glue and varnish, rope and braid, enjoy natural properties? /They/ are misleading the whole world. A slight misconception changed direction; the great delusion changed /human/ nature. How is this known? Ever since the /"Fencer"/ of the "Tiger Wielder" family troubled the Celestial Empire with his call for "mercy" and "justice", everyone, under duress, hastened to follow "mercy" and "justice". Has human nature changed because of /manifestation/ of “mercy” and “justice”?
Let's try /express/ a judgment about this. Since the time of the Three Dynasties, every person in the Celestial Empire has changed his nature because of things. Insignificant people sacrificed their lives for the sake of profit, men - for the sake of glory, military leaders - for the sake of the family, wise men - for the sake of the kingdom. These people have different inclinations, different nicknames, but by sacrificing themselves, they caused the same harm to their nature. /.../ Of those who sacrifice themselves in the Celestial Empire, some do it for the sake of “mercy” and “justice”, then they are usually called “noble men”; others - for the sake of property and wealth, then they are usually called "insignificant people." They sacrifice themselves equally, why do they become “noble” or “insignificant”? /.../ I am ashamed of natural properties, so I do not dare to practice “mercy” and “justice” with the former and do not dare to indulge in vices with the latter.

Chuang Tzu, chapter 8: "Webbing between the legs." Per. L. Pozdnevoy.
Atheists, materialists, dialecticians Ancient China. / Intro. Art., trans. and comm. L.D. Late Era. M.: Nauka, 1967. pp.173-175.
“Mercy” and “justice” are the main Confucian categories; they are equally ethical and normative in nature. A “noble man” is an official, a person who knows the ritual. The above fragment contains Taoist criticism not only of Confucianism in its essence, but also of any normative culture, distorting human behavior, which is violence against his nature.

CHAPTER VIII

WEMBERS BETWEEN THE FINGERS

Webbing between the toes or the sixth finger on the hand are given to man by nature, but do not add anything to our nature. Those who are committed to duty and humanity will perhaps consider them as close to themselves as the organs of the body, but still they do not embody the properties of the righteous Path. It turns out that the webbing between the toes is a useless piece of flesh, and the sixth finger on the hand is an unnecessary appendage. Considering the membrane and the sixth finger to be the true purpose of bodily organs is the same as judging people’s behavior according to the laws of humanity and duty, relying only on one’s own mind.

Therefore, the addiction to contemplation clouds our perception of the five colors, confusing for us all the patterns of the world, just as multi-colored robes blind our gaze. Don't you agree? But Li Zhu's example proves this. The taste for sweetness confuses the five notes of music for us, just as the hymns of Huang Zhuang and Da Liu deafen us. Don't you agree? But the example of music teacher Quan proves this. Taking care of your humanity, like an extra appendage on your arm, means violating your vital qualities and putting obstacles in the way of your nature in order to gain respect and glory and force the world to submit to useless laws to the sound of pipes and gongs. Don't you agree? But scientists Zeng and Shi proved this. He who is fond of controversy, builds towers of tiles and ties knots in rope, inventing sophisticated words and enticing judgments in order to make everyone think about what “hardness” and “whiteness”, “like” and “different” are, and admire empty speeches. Don't you agree? But the examples of Yang Zhu and Mo Di prove this. All these are arts that glorify the external and worthless and are far from the righteous Path in this world.

The one who follows the righteous Path does not depart from his nature and destiny. Therefore, unity with others is not a useless membrane for him, and separation from others is not a worthless outgrowth for him. What is abundant in it is not in excess, and what is scarce in it is not in deficiency. A duck has short legs, but try to stretch them out and you'll make her unhappy. The crane has long legs, but try to shorten them and you will cause him suffering. Therefore, what is naturally long cannot be shortened, and what is naturally short cannot be lengthened. In nature there is nothing to get rid of, in nature nothing can cause us displeasure. But humanity and duty also do not constitute the essence of man. Why do our high-minded men care so much about them?

And besides, try to cut off the membranes on someone’s fingers - and he will cry in pain. Try to cut off someone's sixth finger and he will scream in pain. Among these two, one has more limbs than it should, but it will hurt them equally. The pious people of our time, in their blindness, lament the misfortunes of the world. Scoundrels trample on their nature and their destiny in order to achieve honor and wealth. Therefore, should we not conclude that humanity and duty do not constitute the essence of man? Why has there been so much fuss around them since the Three Dynasties 1?

To rely on compasses, plumb lines and squares to straighten things is to violate their nature. Relying on rope, glue and varnish to hold things together is compromising their vitality. And to bow and bend according to etiquette, to praise humanity and duty, wanting to calm the hearts of people, means to abandon constancy in oneself. There is undoubtedly constancy in the Celestial Empire. But curvature as a permanent property of things does not come from the carpenter’s compass, and straightness as a permanent property of things does not come from his square, the joining of things is not achieved by glue and varnish, the connection of things is not achieved by ropes and knots. This is how all creatures in the Celestial World live and do not know what they owe their lives to. They all equally possess the fullness of vital properties, but they do not know why this happens. Therefore, the past is no different from the present, and nothing in the world will move out of its place. Why do heralds of humanity and duty, in an endless line, as if glued together or tied with ropes, come into this world and preach morality, bringing confusion into minds?

People who are slightly lost go astray. People who are seriously lost turn away from their nature. How do we know this? Since the Yu clan attracted well-behaved men to govern the Celestial Empire, all people in the world have rushed to race for humanity and duty. Doesn't this mean trading one's nature for humanity and duty? Let's try to figure this out. Since the time of the Three Dynasties, every person in the world has exchanged their nature for something else. A lowly man sacrifices himself for the sake of profit, a service man sacrifices himself for the sake of glory, a high-ranking husband does not spare himself for the sake of his family, and a wise man sacrifices himself for the whole world. And no matter how different the occupations of these people were, no matter what memory they left about themselves, they were all the same in that they damaged their nature and destroyed themselves.

Two shepherd boys, Zang and Gu, were tending their flock together, and both lost their sheep. When they were asked what they were doing in the pasture, it turned out that Zang was reading books and Gu was playing dice. The occupations of the shepherds were not the same, but in the fact that they lost sheep, they were exactly the same. Boi died for glory on Shouyang Mountain. The robber Zhi died because of his greed at the Eastern Hill. Both of them died for different reasons, but in that they lost their lives, they were completely equal. Are we to believe that Boi was right and the robber Zhi was wrong? No one in the world can escape death. The one who perishes because of humanity and duty is called a noble man by simpletons. And the one who dies because of treasures is called a low man by simpletons. Although both of them die, one is known as a noble man, and the other as a low man. But the robber Zhi, who killed himself, is no different from Boi. What does it matter who is a noble man and who is a lowly man?

The one who subordinates his nature to humanity and duty, even if he is smart, like the scientists Zeng and Shi, I will not call him great. And the one who violates his nature for the sake of the five taste sensations, even if he is smart like Yu Er, I won’t call him great either. The one who violates his nature for the love of sweetness, even if he is skilled in music, like Master Kuan, I will not call a person with good hearing. And the one who torments his nature for the love of flowers, even if he understands them, like Li Zhu, I will not call him a person with keen eyesight. When I call someone great, I am not talking about humanity and duty, but about the fullness of life properties. Again, when I call someone great, I am not talking about the ability to distinguish between the five senses of taste, but about trust in one’s nature and one’s destiny. When I call someone a person with good hearing, I am not talking about the fact that he can hear others well, but that he knows how to listen to himself. When I call someone a person with keen eyesight, I am not talking about the fact that he sees others well, but that he knows how to peer into himself. To look at others and not look at oneself, not to comprehend oneself, but to comprehend others means acquiring what belongs to others and not acquiring what belongs to oneself. This means adjusting to what others want, and not adjusting to what pleases oneself 2 . If you live only for what pleases others, and not live for what pleases yourself, then both Boi and the robber Zhi, one might say, “fell into excess.” I bow to the righteous power of life, and therefore I do not want to exercise myself in the exercise of humanity and duty, nor to live in such a way as to “fall into excess.”

It’s great if the baby was born healthy! But sometimes parents are surprised to discover strange defects in him. Take, for example, the fused toes of a newborn. They can sometimes explain the reasons for this pathology by the fact that in their family the named special feature is passed on from generation to generation, but sometimes it can be quite difficult to understand what triggered the development of the defect. We will talk about what syndactyly is (fusion of the fingers of the upper or lower extremities) and why it develops in our article.

Syndactyly is not common

Those present in the child's hands are recorded quite rarely - in one case per 2-3 thousand newborns. Moreover, this occurs 2 times less often in girls than in boys. Most often the 2nd and 3rd toes or the middle and ring fingers on the hand are fused. Most often, such fusion does not affect the joints and tendons, making the problem only cosmetic.

And if the fingers, as a rule, are subjected to surgical separation, then the legs are often not touched, not seeing the defect as a particular obstacle to the child’s development (such a violation usually does not interfere with normal walking). True, in the presence of syndactyly, 60% of such children most often have another congenital pathology of the limbs - foot deformity, pseudarthrosis, clubfoot, etc.

Fused toes in a newborn: causes of pathology

What causes syndactyly? The fact is that the baby’s fingers and toes are formed at 4-5 weeks of pregnancy, when the mother usually does not even suspect it, and therefore does not limit herself in anything. This raises the possibility that the fetus may be affected by harmful factors - x-ray radiation, taking antibiotics, alcohol, smoking, etc. The danger of severe consequences for a pregnant woman and her fetus from diseases such as influenza, mumps or syphilis cannot be ruled out.

And the most common reasons why a newborn’s toes become fused is heredity, which is passed on from parents to children.

By the way, if syndactyly is detected in a child, even to a mild degree, he must be examined for the presence of gene and chromosomal Apert, Poland or Edwards), in which fusion of the fingers is one of the symptoms of serious developmental defects in the baby.

By the way, in medical practice there have also been cases of acquired fusion of the fingers as a result of a chemical or thermal burn of the hand or foot.

We will talk further about what to do if a baby has fused toes and fingers, but for now, a little theory.

How is pathology classified?

In medicine, the pathology we are considering is classified depending on the condition of the bones and the degree of fusion. Thus, according to the type of adhesions, syndactyly can be soft tissue and bone, and according to the size of the fusion - complete and incomplete.

Depending on how exactly the toes or toes grow together, syndactyly occurs:

cutaneous membranous - between the fingers there is a membrane of skin ( this type pathology is considered the easiest);
cutaneous - between the fingers there are with the underlying soft tissues, most often along the entire length of the fingers;
bone - fusion occurs at the level of the phalanges, and they are, as a rule, underdeveloped or deformed;
combined - there are several types of syndactyly (this form is considered the most difficult to treat).

Diagnosis of syndactyly

As a rule, syndactyly is detected already in the first hours of a newborn’s life, when examined by a neonatologist. If a child’s toes are fused, then the question of the need for surgery, as a rule, is not urgent, and parents have the opportunity to weigh the pros and cons of surgery.

In order to have a complete picture of the pathology, the baby should be shown to a pediatric surgeon and an x-ray of the foot should be taken in two projections. This will allow us to determine the characteristics of the defect and the condition of the baby’s bones and joints.

How is syndactyly treated?

And yet, regardless of why the toes grow together, the only treatment for this pathology is surgery.

The optimal age of the baby for this is 4-5 years. However, if the ends are connected, it is better to carry out the operation before one year of age in order to prevent uneven growth of the fingers and their deformation.

Operations to eliminate syndactyly are divided into 5 groups:

Simple dissection for membranous fusion.
Dissection using skin grafting with local tissue.
Dissection using a full-thickness or split-thickness skin flap.
Dissection using combined skin grafting (free autografts or local tissues are used).
The operation consists of several stages, including bone, tendon-muscle and skin plastic surgery.

Which of the listed operations will be the most optimal, the doctor will decide, taking into account the nature and forms of the pathology.

Postoperative period: how long does it take for a toe to grow together?

After surgery, the recovery period usually takes place at home. The limb needs rest at this time (for a month). It is necessary to follow all the doctor’s instructions, ensuring proper care of postoperative wounds.

To reduce the inflammatory process and get rid of scars, they are lubricated with Dermazin ointment or Contractubex gel, and after about 7 weeks, as prescribed by a specialist, they begin to attend physiotherapeutic procedures. By the way, there is no need to rush into this - let the postoperative wounds heal properly so as not to cause pain to the child during new procedures.

In some cases, it is also prescribed to wear turbocast spacers so that the sutures on the operated fingers do not fuse. At first (for a month) they are worn constantly, and then put on only while sleeping.

It should be noted that if you follow all the instructions, you will soon forget about the problem we are considering (the child has fused toes). The patient will recover quite quickly and without complications.

Forecast

Despite the fact that cases of syndactyly have become more frequent in our time, for which researchers have not yet found sufficient explanations, the prognosis for the course of this pathology is generally favorable. Modern treatment methods make it possible to get rid of the defect, restoring all functions of the hand or foot and correcting the deformation of the fingers.

If the baby’s toes or fingers are fused, then the operation allows the formation of normal interdigital spaces and at the same time maintain the mobility of the joints and the sensitivity of the patient’s fingers. That is, to save him from any difficulties associated with syndactyly.

Is it necessary to have surgery for syndactyly of the toes?

Almost always, parents, having discovered problems with their baby’s fingers, begin to insist on immediate surgery. But if fused fingers can indeed cause not only aesthetic, but also physical problems, then in a situation where there is a defect on the feet, especially if the fingers are not deformed and bend normally, you can do without surgery.

If a woman’s fused toes can cause a lot of negative emotions, including a reluctance to wear open shoes or walk barefoot on the beach, then a child, as a rule, does not yet have such a problem and will not, naturally, have the right attitude towards it. Many people live without experiencing any discomfort from fused toes. And for some, this special sign also becomes a kind of highlight. As you can see, everything depends only on whether you accept yourself as you are.