BIPEDAL

Brachymetatarsia

Episode Summary

Brachymetatarsia is a structural condition in which one or more metatarsal bones are abnormally short, most often because of premature closure of a growth plate. The fourth metatarsal is most commonly affected. Some patients experience altered toe position, forefoot pain, calluses, or footwear difficulties, while others are primarily concerned about appearance. This episode explains the causes, presentation, diagnosis, and treatment of brachymetatarsia, including single-stage metatarsal lengthening with a bone graft and gradual lengthening through distraction osteogenesis. It reviews published outcomes and complications and emphasizes realistic expectations regarding recovery, cosmetic improvement, and the importance of individualized surgical planning.

Episode Notes

• 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.