Amniotic band syndrome!!!
Above is a patient with constriction bands surrounding the base of the toes in the right lower limb extremity associated with marked lymphedema and slight right clubfoot! This is a congenital disorder caused by entrapment of fetal parts (usually a limb or digits) in fibrous amniotic bands while in utero. The theory believed is that is occurs due to a partial rupture of the amniotic sac. This rupture involves only the amnion while the chorion remains intact. Fibrous bands of the ruptured amnion float in the amniotic fluid and can encircle and trap some part of the fetus. Later, as the fetus grows but the bands do not, the bands become constricting. This constriction reduces blood circulation, hence causes constriction of the developing tissue and congenital abnormalities. These can be anywhere including fingers, toes, the lower leg, the arm. They can also affect muscle quality and strength, proximal and distal to the band. Depending on the severity of the constriction, the defect may be as minimal as a merely cosmetic band. Deeper bands, if tight enough, may cause lymphatic obstruction leading to edema and vascular compromise that necessitates immediate surgical release.