by Al Kline DPM¹

Podiatry Internet Journal  1 (1):5  

Brachymetatarsia is an congenital idiopathic inherited trait of usually the fourth metatarsal that causes sesation of growth and resultant shortening of the 4th metatarsal shaft. It affects mainly women. In most women, it is a embarrassing condition that causes shortening of the 4th digit and often, surrounding transfer pain to the third and fifth metatarsal heads.

Case Presentation

A 34 yo female presents to my office with no gross complaints of pain, however, when she was 16 years old, she had ‘correction’ of brachymetatarsia performed by a local orthopedist. She has had the condition as long as she can remember. She states ,after the surgery, the 4th right toe was always shortened, and after the surgery , got longer, but was not “normal”. She is now concerned that the toe is shortening “more” and she is having some pain due to the toe contracture while in shoes.The patient is allergic to ASA (anxiety). She is on effexor, Vitamins and Ambien. She has a history of Asthma and Anemia. Her surgical history includes foot surgery and laparoscopy for endometriosis. She does not drink or smoke. She has a family history of DM, HTN and Heart disease. She appears very healthy and is active. Radiographic Presentation

Findings

The radiograph confirms unusual treatment in this young lady for brachymetatarsia, by using a silicone silastic implant. This is actually the first case I’ve seen implementing an implant in a healthy joint to correct brachymetatarsia. Her toe purchases the ground, but is about 1cm short. I can physically pull the toe to length on examination. It is quite flexible.

Discussion

Brachymetatarsia is usually treated by lengthening of the bone by a number of techniques including lengthening osteotomies of the metatrsal ,internal bone grafting or sequential lengthening and external callus distraction devices. Depending on the length correction needed, pre-operative tissue stretching exercises, operative z-lengthenings of both tendons and v-y skin lengthening is often indicated.

Question

How would you now treat this condition? Would you remove the implant, knowing the joint has been damaged by insertion of an implant in a health joint? Would you attempt lengthening or callous distraction with the implant in place? Would you leave the implant in, and do a lengthening osteotomy?  What about neurovascular changes to the toe if you lengthen it in one step?  You may leave your comments below:

¹Dr. Kline is in private practice in Corpus Christi, Texas. He can be reached by email at al@kline.net.

© Podiatry Internet Journal , 2006