Effective Treatments for Brachymetatarsia
Brachymetatarsia (a shortened toe) is an uncommon condition of the foot characterized by shortening of metatarsal bones. Brachymetatarsia occurs when there is one or more abnormal growth in the short or overlapping toe metatarsals (any bone of the foot between the ankle and the toes), most commonly affecting the 4th metatarsal. When the 4th metatarsal is involved, the 3rd and 5th metatarsi are burdened, and result in skin lesions, pressure, fractures and pain. However, if it involves the 1st metatarsal, the condition is known as Morton’s syndrome.
Problems arising from this condition include cosmetic concerns, pain and difficulty with shoe wear. A short toe is always unpleasant and is commonly associated with pain. People with short toes tend to hide their feet and avoid being bare foot.
Brachymetatarsal is more common among women than men. In some cases brachymetatarsia causes no discomfort and may be well treated with careful shoe selection, while others require surgical treatment according to the American college of foot and ankle surgeons.
Although the exact etiology of brachymetatarsia is unknown, it is thought to be due to any of the following reasons:
- Retarded growth: When the growth in the bones of the toes (metatarsal bones) slow down or stop in early childhood
- Premature closure of the epiphyseal plate: When the growth plate closes, the developing stage is stunted, whereas the surrounding bone grow normally
- Trauma: Although trauma, such as an accident may cause brachymetatarsia, genetic factor also plays a role.
- Congenital disorder: According to the Journal of Pediatric orthopedics, brachymetatarsia may be congenital and associated with systematic diseases such as Down’s Syndrome, Aarskog-Scott syndrome, pseudohyperparathyroidism turner’s syndrome, Apert syndrome and multiple epiphyseal dysplasia.
Risk associated with toe length surgery: General risk of brachymetatarsia surgery include:
- Temporary or permanent pain
- Infection
- Hematoma
- Swelling
- Incision breakdown
- Poor wound healing
- Blood clot
- Poor bone healing
- Bleeding
- Stiffness
- Weakness in toe
- Need for revisional surgery
- Nerve injury
- Disability
- Unsightly scar
There are several surgical as well as non-surgical treatments to correct a short toe, depending on the severity of the affected metatarsal bone and also other considerations such as patient’s activity level and gait pattern.
Nonsurgical treatment: Non-surgical methods for brachymetatarsia are designed to relieve symptoms such as pain or calluses.
- Digital padding and toe splinting: Specific padding shoes that contain extra depth to ease the toe from the pressure and physical irritation in shoes. However, this condition can be a real issue in women who are required to wear dress attire on a daily basis.
- Customized foot orthotics (artificially supporting bones): This is another option available to lessen the condition.
- Anti-inflammatory medicines: Prescription strength medicines to reduce pain and inflammation.
Surgical treatments: The goal of surgery is to restore the length to the short bone. Although there are numerous methods available, three main toe-lengthening procedures are used today.
- Callus distraction method: The medical literature has various surgical procedures for the correction of this problem. Currently, the callus distraction technique has been used for this problem. A study published in the Journal of Foot Ankle Surgery, demonstrated the utilization of the callus distraction technique for the correction of congenitally short metatarsal. Before surgery, metatarsal length ranged from 3.5 to 4.2 cm and the end stage metatarsal length ranged from 4.7 to 6.3 cm, with an average increase in length of about 1.68 cm. The callus distraction technique has good advantages as compared to other techniques described in the medical literature.
- Distraction osteogenesis: A study published in the Journal of pediatric orthopedics examined this method on 17 brachymetatarsia patients with 39 metatarsal bones for toe lengthening. The study showed that lengthening was successful except in 1 case with mean lengthening of 19.5mm for the 1st metatarsal and 17.1mm for the 4th metatarsal.
- Bone-graft lengthening: This is a common one-stage method where the toe length is gained by placing a structural bone graft into the short bone. The bone graft size is settled on the amount of length that is needed. Dr Neal M. Blitz, DPM, FACFAS, a pioneer in tarsal coalition surgery and a Board Certified Reconstructive Foot & Ankle Surgeon usually considers this procedure for toes that require less than one centimeter of lengthening. The bone graft is stabled with a bone plate and screws that stay in the foot.
