Brachymetatarsia is a condition affecting the foot in which one of the metatarsal bones remains shorter than the rest. This results in a short toe or floating toe deformity. This commonly affects both feet and the 4th metatarsal is the most commonly affected bone. This condition is caused by an abnormal arrest and closure of the growth plate earlier than the remainder of the metatarsals. This is commonly a congenital condition but can be acquired due to trauma, infection, bone tumors etc. Women are more likely to be affected than men with a 25:1 ratio.
Symptoms are painful ambulation with or without shoes and cosmetic appearance of the deformity. Pain is due to the abnormal distribution of weight during ambulation since the normal metatarsal parabola is not maintained. The abnormally riding toe can cause irritation with shoe gear.
Diagnosis is clinical but X-rays are taken to confirm and assess the degree of shortening. Often CT scans are taken to assess other bony abnormalities.
Treatment is initially conservative with shoe gear modification, custom orthotics, activity modification. These treatments often fail and surgical intervention is necessary. This includes lengthening of the affected metatarsal surgically. A few different techniques can be utilized to address this deformity. The shortened bone is cut and a graft is placed to bring its length out to normal so the parabola is restored. The graft can be an autograft or an allograft. Autografts are harvested from the patient's own body and incorporation of this graft at the site of the shortened metatarsal is higher. Allografts are cadaver bones and they are utilized as well to avoid donor site morbidity. The graft is secured in place by pains and screws or a uniplanar external fixator is used.
Please see one of our physicians & surgeons if you suffer from this condition and see if you or your family member is a candidate for these type of surgery.