Brachymetatarsia

What is brachymetatarsia? Shortening of one or more metatarsal bones, often causing a toe to appear shorter or sit farther back than neighboring toes.Common causes: Premature growth-plate closure, developmental or genetic factors, and less commonly growth disturbance following trauma, infection, or surgery.Prevalence findings: Surgical literature shows a marked female predominance and identifies the fourth metatarsal as the most frequently affected. These are clinical-study findings, not precise general-population prevalence estimates.Symptoms: Cosmetic concerns, difficulty with shoes, toe malposition, calluses, and sometimes metatarsalgia.Diagnosis: Clinical examination and weight-bearing radiographs.Nonsurgical care: Footwear modification, padding, orthoses, and activity adjustments can address symptoms but do not lengthen the bone.Surgical correction: Single-stage lengthening with grafting versus gradual lengthening through distraction osteogenesis. For minimal deficits (up to 5-6mm) certain osteotomies can effectively lengthen the bone without the need for more complex reconstruction. For deficits up to 1cm, interposition bone grafting is often performed. Beyond this point we have to consider the acute lengthening in the setting of vascular stretching which can result in compromised perfusion to the toe. In these circumstances gradual distraction is preferred.  Patient expectations: Length gains and appearance vary. Recovery can take months, and stiffness, malalignment, delayed bone healing, infection, and additional surgery are possible. The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.