Brachymetatarsia.

By: Dr Alireza Khosroabady DPM Click author's name for more of his/her articles

Brachymetatarsia or short toe/s, 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.

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.

The treatment for brachymetatarsia is very limited. Treatment, 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 it 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.

A well-educated patient should understand the potential complications of the procedure and be able to weigh the risks and benefits of the surgery. If the patient then chooses to pursue the surgery, this knowledge should help him or her have realistic expectations. This will usually result in a happier postoperative patient and a higher degree of surgical success. This is a demanding procedure postoperatively on both the surgeon and the patient.

However, it can be a very rewarding surgery with limited complications if the surgeon is diligent in the surgical execution and the patient is diligent in the postoperative regimen.

Copyright (c) 2009 Dr Alireza Khosroabady DPM

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About The Author: Dr. Alireza Khosroabady is a Fellowship trained foot and ankle surgeon. He finished his surgical residency in New York. He also completed a one year fellowship at the Rubin institute for Advanced Orthopedics / International Center for Limb Lengthening at Sinai Hospital in Baltimore Maryland with world renowned Orthopedic Surgeons. He is practicing in Los Angeles CA . More information visit www.fixmyfoot.com you can request his free book.