What Is Brachymetarsia (short toe)?

  • Brachymetatarsia is a condition where there is a growth disturbance to a bone in the foot creating a short toe. 
  • The fourth toe is the most common toe that is affected, though any toe can be affected.
  • The toe itself is usually normal length, but the bone the toe attaches to in the foot (metatarsal bone) is short.
  • Typically with brachymetatarsia, the metatarsal bone growth is stunted whereas the surrounding bones grow normally.

Symptoms of brachymetatarsia

  • The most common symptom is pain and callus formation at the bottom of the adjacent toes. 
  • Callus formation is secondary to inadequate weight distribution that is caused by the short metatarsal. 
  • Patients with short toes tend to hide their feet and avoid being barefoot. Children and young adults are most psychologically impacted.

What are the Causes of Brachymetatarsia?

  • The most common cause of a brachymetatarsia is hereditary.
  • Trauma to the affected toe can also play a role, especially in cases where there was an injury to the growth plate.
  • Brachymetatarsia may occur in people with Psuedophypoparthyroidism or Downs syndrome.
  • The most common metatarsal affected is the 4th metatarsal. 

When to seek treatment?

Common reasons patients seek treatment include: 

  • Pain on the ball of the foot, which, interferes with walking or activities
  • Problems with fitting shoes due to pain
  • Change in the appearance of the toes
  • Unsightly appearance/psychologically embarrassing

Non – Surgical Treatment Options

  • Wear proper supportive shoe
  • Use of foot orthotics
  • Modify your activities
  • Decrease physical activities
  • Anti inflammatory medications

Pads/Splints to take pressure off affected areas

Lengthening Surgery 

Surgical options:

There are 3 different ways to correct a short toe:

  1. Sliding lengthening osteotomy
    • only used for mild cases with minimal shortening
    • specifically angulated cut is made in the bone to allow for lengthening of the bone
    • the osteotomy is held in place by metal screw and/or plates
  2. Lengthening with use of bone graft
    • typically used for moderate to severe shortening 
    • a one stage procedure where a bone graft is inserted into the short bone to achieve lengthening
    • the inserted bone graft can be kept in place by wires, screws or plates
    • the maximum recommended lengthening with this procedure is limited to one centimeter
    • the graft can be taken out of the patients own heel bone, which increases chances of success
  3. Brachymetatarsia External Fixator lengthening
    • can be used for any severity of shortening and can gain the desired length
    • also referred to as a bone growing procedure(osteogenesis)
    • in this multiple stage procedure, Dr. Majdanski makes a precise bone cut at the base of the affected metatarsal, which preserves the blood supply to the area. Following this:
      • an external fixator is applied over the bone cut and left in position without any manipulation for about 7-10 days
      • after the initial stage, the patient turns a knob on the device, 4 times a day, until the desired length is reached
      • once the desired length is achieved the external fixator is locked in place for a specific period of time to allow the bone to fully heal, at which point the device is removed

Brachymetatarsia Surgery Recovery

  • Recovery after brachymetatarsia surgery depends on the type of surgery performed, and the amount of shortening that needs to be corrected. 
  • The minimal amount of time is generally 2 months. Large defects where the external fixator is used can involve casting up to 3 months. 
  • Factors that may prolong healing are age, smoking, poor nutritional status, and some medical problems.

What Anesthesia Is Needed For Bracymetatarsal Lengthening Surgery?

  • Brachymetatarsia surgery is performed as outpatient surgery. 
  • It may be performed in a hospital or an ambulatory surgery center.
  • The surgery is most commonly performed under sedation with local anesthesia but can be performed under a local, regional, spinal or general anesthetic. 

What are the risks of brachymetatarsia surgery?

  • Just as any other surgery, shirt toe lengthening surgery has general risks.
  • Complications may occur with any surgery and are not necessarily your fault, or the fault of your surgeon. Nonetheless, you should understand the risks.
  • Complications include, but are not limited to: infection, pain (temporary or permanent), swelling, hematoma, bleeding, blood clot, poor wound healing, incision breakdown, poor bone healing (delayed union, nonunion), nerve injury, disability, recurrence, scarring, stiffness, weakness, hardware problems, need for revisional surgery, and/or catastrophic loss.