Brachymetatarsia
Specialist

Does brachymetatarsia include pain?

During the beginning of brachymetatarsia, the pain isn’t noticeable, but as time goes by there is usually more pain and callouses underneath the nearby toes, which are bearing the extra weight.

What causes brachymetatarsia?

Brachymetatarsia is caused by genetics (born with) or traumatic events such as injuries. For people who are born with brachymetatarsia, the exact cause is not completely known.

Can brachymetatarsia be prevented?

Prevention of a brachymetatarsia is not possible as it is caused by genetics or trauma. Fortunately, an experienced foot doctor can treat brachymetatarsia.

How is brachymetatarsia treated?

Early treatment may include wearing shoes with extra room (for the shortened toe) and extra padding to lessen friction and irritation. By treating the shorter toe with an orthotic device, the body’s weight can be more evenly supported by all the toes.

Anti-inflammatory oral medications or an injection of medication (by your foot doctor) may help reduce swelling and pain. Your foot doctor may also recommend a surgical procedure to fix the structural problem in your foot caused by brachymetatarsia.

What kind of surgery is best for brachymetatarsia?

There are two types of surgery for brachymetatarsia, bone graft or toe lengthening.

A bone graft involves surgically cutting the short toe’s bone in half and inserting (grafting) a separate piece of bone between the two ends of the original bone. A patient does not put weight on their foot for six to ten weeks while the bone graft heals.

Another type of surgery is a less invasive toe-lengthening procedure called an “osteotomy” (my preferred method).

Toe lengthening involves the short toe’s bone being stretching by a device called an “external fixator, “ which is surgically placed into the short toe’s bone. With this procedure, no bone graft is needed and only a small incision is done.

Over several weeks, the short toe is lengthened by the patient, who makes a very small daily adjustment by slowly turning the external fixator (after being taught how by a foot doctor). The patient can lengthen the short toe by 1/2 mm a day, simply by turning a screw at home.

This is usually a painless process that is much like slowly moving teeth with braces. Unlike bone grafting surgery, a patient is able to put weight on their foot with crutches during this process.

The external fixator is usually removed six to ten weeks after the toe lengthening surgery and the patient may return to wearing shoes shortly after that.

Should you have toe-lengthening surgery?

People with brachymetatarsia are prime candidates for have toe-lengthening surgery, which results in a normal foot appearance and a much-improved ability to walk, balance and stand.

To learn more about this procedure, please Contact Us or call us at 1.877.366.8911.



What Type of Short Toe Lengthening Surgery is Best?


Ever wonder if you were the only one with a short toe on your feet? You are not alone. Short toes can be caused by many things including a prior surgery or a prior injury. Another cause of short toes is brachymetatarsia, which is when people are born with a short toe bone or a short bone behind the toe.

How can short toe (brachymetatarsia) be corrected? People who have brachymetatarsia may initially try non-surgical procedures.

Initial treatment involves wearing shoes with extra depth to allow more room for the shortened toe. Padding can help protect the toe from pressure and friction from the top of the shoe, which may cause ulcerations. Orthotics may be used to relieve pressure under the other toes.

However, toe lengthening surgery is often needed for a permanent correction of brachymetatarsia. There are two types of surgery for brachymetatarsia, a bone graft or a osteotomy.

A bone graft surgery involves obtaining a bone graft from somewhere in the body, usually the hip or heel bone, and placing the graft in the short metatarsal. The graft is usually held in place by a plate and screws and is usually used for smaller corrections. A person would not put weight on his or her foot for six to ten weeks while the bone graft heals.

A newer technique called an ‘osteotomy’ involves a small bone stretching device called an external fixator which is surgically placed into the short metatarsal. No bone graft is required and only a small incision is needed.

Over the next several weeks the short metatarsal is lengthened by the person slightly turning a bolt on the external fixator. This is usually a painless process and a person is able to bear weight on their foot with crutches to balance during this process.

By teaching people how to make very small daily adjustments to the frame, this gradually changes the position of the bone, like braces that gradually move crooked teeth. It can either lengthen or straighten the bone, depending on the goal. People usually spend one or two nights in the hospital.

The external fixator is usually removed six to ten weeks after the procedure depending on the amount of toe lengthening needed and the person may return to shoes shortly after that.

Remember, any type of foot or ankle pain is never normal. A foot and ankle doctor can examine your feet and give you the best course of action.



Should You Have Toe Lengthening Surgery?


Should you have toe lengthening surgery? People with brachymetatarsia, a short bone in the foot, are candidates for this procedure.

People with brachymetatarsia usually have a “floating” toe which is shorter than others and does not bear weight as much weight when you standing. The fourth metatarsal and toe is the most common “short toe.”

A main cause of a brachymetatarsia is an early closing of the growth plate in a metatarsal (the exact cause is not know). Some people are born with brachymetatarsia , while others have it due to traumatic events.

An early diagnosis may include orthotics or other adjustment of your footwear. By supporting the shorter toe with an orthotic device, the weight load can be more evenly spread over all five toes and preventing pain with callouses.

For pain symptoms, anti-inflammatory medications or an injection of medication and local anesthetic can reduce this swelling. Your foot doctor may also recommend a surgical procedure to actually fix the structural problem of your foot.

For a permanent solution, toe lengthening surgery may be the best option for you. The procedure can involve bone grafts, bone external fixators, and/or internal fixation.

Surgical treatment is done by surgically cutting the bone and either grafting a bone between the two ends or putting a device on the bone to lengthen the bone gradually (preferred method). That way, the patient can actually lengthen the bone 1/2 mm a day which is done by turning a screw at home (totally pain free).

After toe lengthening surgery, you may need a cast to protect your toe for a short time. Sometimes a soft bandage with a post-operative shoe is allowed. You should expect some pain following surgery as well as swelling. Especially for the first 48 hours you should keep your leg elevated and occasional ice placed over the area of surgery.

Toe lengthening surgery surgery may require you to keep all weight off of your foot for several weeks, typically 5-8 weeks depending on exact procedure. Your foot surgeon may allow you to place some weight on the heel. You may use crutches, a walker, or wheelchair to help you keep weight off of this foot. Healing time is typically 6-8 weeks.

The result of toe lengthening surgery is a normal-looking appearance and a better ability to walk, balance and stand

Remember, any type of foot or ankle pain is never normal. A foot and ankle doctor can examine your feet and give you the best course of action.

Please call 626-447-2184 (Arcadia) or 818-408-2800 (San Fernando) to speak to a foot and ankle specialist about your foot and/or ankle needs.



What is Brachymetatarsia?

Overview

Brachymetatarsia is a condition in which one of the five long bones of the foot (the metatarsals) is abnormally short, resulting in a shortened toe. This condition usually occurs in both feet (i.e., bilaterally) and in the fourth toe. If it affects more than one toe, the condition is called brachymetapody.

Causes

The most common cause of brachymetatarsia is when the growth plate of the bone stops growing too soon. This may be caused from trauma, infection or a genetic predisposition.

Symptoms

During Walking, The weight is normally distributed from the 5th toe to the 4th and so on until it reaches the 1st toe (big toe). The weight and pressure gets distributed and transferred across the ball of the foot evenly. An abnormally short Metatarsal will disrupt this process. If there is a short 4th metatarsal, this means that the weight distribution goes from 5th toe to 3rd toe and either the 5th or 3rd metatarsal bones bear more weight than usual causing the pain and discomfort i.e. callus on the ball of foot.

Treatment

The treatment for brachymetatarsia is very limited. Conservative treatment includes shoe modification (more room in the toe box area). Padding of the shoe to relieve pain in the high pressure area. Orthosis may be used to distribute the weigh to other bones.

Surgical treatment is performed to lengthen the bone to its ideal length. This is done by surgically cutting the bone and either 1. Grafting a bone between the two ends 2. Putting a device on the bone to lengthen the bone gradually (my preferred method).

I like the lengthening method because it give the surgeon more control of how much he/she can lengthen the bone. I usually have the patient lengthen the bone 1/2 mm a day which is done by turning a screw at home (this process is totally pain free).

Problem with method #1: If the bone needs significant lengthening and the surgeon tries to graft a bone that is too long ,the tendons, arteries and veins might not cooperate. This will result in lost of blood supply to the bone and eventually loosing the toe.