Objective To explore the structural abnormalities and reconstruction strategies of polydactyly of the fifth ray

combined with bunionette deformity in children， and to analyze the impact of surgical methods based on anatomical reconstruction principles on functional recovery and growth safety. Methods A retrospective analysis was conducted on 11 consecutive cases of pediatric polydactyly of the fifth ray with bunionette deformity admitted from January 2018 to October 2024. Preoperative imaging measurements， such as the intermetatarsal angle between the 4th and 5th metatarsals and the fifth metatarsal valgus angle， were performed to assess lateral column alignment abnormalities. Based on the anatomical characteristics of the deformity， surgical interventions included polydactyly excision combined with fifth metatarsal osteotomy for correction， Kirschner wire internal fixation， and autologous bone grafting were performed. Pre- and postoperative imaging indicators were compared， and the AOFAS forefoot score was used to evaluate functional recovery. Statistical analysis of imaging data was performed using paired t-tests. Results All patients were followed up for 12 months. The intermetatarsal angle between the 4th and 5th metatarsals， the 5th metatarsal valgus angle and the varus angle of the 5th metatarsophalangeal joint were （12.29±1.5）°，（7.74±1.7）° and （9.7±4.1）° respectively before the operation. The postoperative values were （6.18±1.4）°，（4.25±1）° and （7.63±3.4）° respectively. The postoperative values were significantly improved compared with those before the operation （P<0.01）. The postoperative AOFAS score was （93±4.1） points. All patients were satisfied with the improvement of the appearance of the affected foot and significant relief of symptoms. During the follow-up period， no epiphyseal injury， metatarsal head necrosis， or significant recurrence was observed. Conclusion The occurrence of  bunionette deformity combined with polydactyly of the fifth ray in children is closely related to abnormal development of the lateral metatarsal bone and imbalance of force lines. Based on the concept of structural reconstruction， osteotomy correction can restore the anatomical continuity and biomechanical balance of the lateral column of the foot， balancing functional improvement and growth safety， and has good clinical application value.

Children, Polydactyly of the fifth ray, Bunionette deformity, Structural abnormalities, Reconstruction