Brachymetatarsia: causes, symptom and treatments

Updated 1/9/2024
Brachymetatarsia: causes, symptom and treatments

What is brachymetatarsia?

Brachymetatarsia is a relatively rare condition that occurs when one or more of the toe bones (metatarsal bones) is significantly shorter than the others.

 

It can be a congenital condition or acquired and is most often seen bilaterally (affecting both feet) involving the fourth metatarsal. If there is more than one shortened toe on the foot, it is termed brachymetapody. When the condition affects the first metatarsal, it is referred to as Morton’s syndrome.

What are the causes of brachymetatarsia? 

A shortened metatarsal can be a result of trauma to the foot during fetal development that resulted in premature closing of the growth plate. It can also be genetic.

 

Genetic brachymetatarsia causes include:

 

  • Down’s syndrome
  • Albright’s syndrome
  • Turner syndrome
  • Changes in parathyroid levels

 

How is brachymetatarsia diagnosed? 

Generally, the shorter toe will be apparent when looking at the foot. However, for proper treatment, our podiatric experts will need to rule out other potential problems with similar symptoms (such as hammertoes).

 

An X-ray allows us to see the bones and determine if brachymetatarsia is the root cause of your child’s foot problem.

 

The severity of symptoms varies from person to person, and mild brachymetatarsia may only present with one toe slightly shorter than the other or overlapping the other.

 

In more severe cases of brachymetatarsia, the shorter toe may sit higher on the foot and be more pronounced, causing it to rub on shoes. Calluses can develop on the ball of the foot due to uneven weight distribution. Severe cases can also result in plantar pain due to a change in the mechanics of the foot. If the condition affects the first toe, it can also present with a bunion.

 

Should I get treatment for brachymetatarsia? 

Some individuals with brachymetatarsia experience no painful symptoms or symptoms that affect the mechanics of their foot. Therefore, no treatment may be needed other than to modify footgear to accommodate the shorter toe. Other patients may seek out treatment for either functional or aesthetic reasons.

 

While cosmetic factors may be involved, the most common reason to have a toe corrected is due to pain. When brachymetatarsia affects the fourth toe, the toe can lift and crossover the third or fifth toe. This abnormal position can lead to discomfort when wearing shoes and participating in weight-bearing activities. When the affected toe does not lie flat and straight, it’s unable to adequately support your forefoot and, in turn, transfers weight to adjacent metatarsals.

 

Also, certain cases of brachymetatarsia can alter the alignment of your foot, resulting in faulty biomechanics. Both of these instances can lead to pain, discomfort, and additional foot problems.

 

What is the treatment of brachymetatarsia? 

At University Foot & Ankle Institute, our podiatrists opt for non-invasive treatment options whenever possible — especially when dealing with children whose feet are still growing. Non-surgical treatment options don’t directly treat the short toe, instead, they help manage pain and discomfort.

 

Conservative management of brachymetatarsia includes:

 

  • Custom orthotics and arch support
  • Modification of activity
  • Use of supportive shoes with a wider toe box
  • Anti-inflammatory medication to reduce pain and inflammation

 

However, when surgery becomes the best option, we have multiple surgical intervention techniques to choose from. Surgery often involves a bone cut or fracture to increase the length of the metatarsal. Lengthening can be gradual or acute.

 

Gradual lengthening 

Gradual lengthening happens using an external fixator. The external fixation device sits outside the foot and is internally attached to the short toe. The patient regularly adjusts the device to stretch the bone and the surrounding soft tissues until the desired length is achieved.

 

Acute lengthening 

Acute lengthening occurs with a bone graft. Bone from the patient or a donor is used to fill in a surgically created space between the ends of each bone of the short toe. After surgery, a splint or orthopedic boot will need to be worn for six to eight weeks. In some cases, a combination of acute lengthening and an external fixation device during the bone healing process may be recommended.

 

Our podiatry specialists will discuss which metatarsal lengthening surgical technique is best for your specific condition, as well as what to expect during recovery.

 

What is Brachymetatarsia surgery recovery time? 

Brachymetatarsia foot surgery recovery depends on the amount of correction needed and the type of surgery performed. Gradual lengthening through an external fixator generally requires at least four weeks, though slow bone growth or a longer desired length can take up to three months. 

 

The typical toe lengthening surgery recovery time for acute lengthening is at least three months. It is often six to eight weeks before the boot can be removed. However, complete healing of the bone, at which point the foot can bear full weight, needs about three months.

 

How soon can I walk following Brachymetatarsia surgery? 

Walking after short metatarsal surgery depends on the type of surgery performed, the stabilizing techniques used for the bones while they mend, and the amount of correction that was needed. 

 

Typically patients are non-weight-bearing for a minimum of six to eight weeks and can be mobility-limited for up to three months. Our podiatrist will work with you to create a complete treatment and recovery plan.

 

Reach Out to UFAI for your Pediatric Foot and Ankle Conditions 

The physicians at the University Foot and Ankle Institute have decades of combined experience treating all forms of adult and pediatric foot and ankle concerns. Our podiatrists use the latest technologies available to successfully treat brachymetatarsia of all stages and severity levels. 

 

To schedule a consultation, please call (855) 872-5249 or make an appointment now.

 

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Santa Barbara, and Valencia.

 

brachymetatarsia FAQs

Brachymetatarsia FAQs 

 

Is brachymetatarsia a disability or birth defect? 

In general, brachymetatarsia is not considered a disability in the conventional sense. The condition can be congenital, meaning it exists at birth, or it can be the result of trauma.

 

How rare is brachymetatarsia? 

According to the National Institute of Health, congenital brachymetatarsia has an incidence of just 0.02% to 0.05%, making it a rare condition.

 

Can you fix brachymetatarsia without surgery? 

Brachymetatarsia discomfort can be managed conservatively by wearing adaptive shoes and modifying activity, but it cannot be esthetically or functionally fixed without surgical intervention.

 

  • Dr. Gina Nalbandian, DPM

    Dr. Gina Nalbandian specializes in reconstructive and revisional foot and ankle surgery, foot and ankle trauma, sports medicine, lapiplasty, and limb salvage.

     

    While an undergrad, Gina volunteered at free clinics, hospitals and with the AIDS Project in Los Angeles, all the while exploring various careers in medicine. She also conducted and published her research in the lab on campus. “I soon found out that the lab life wasn’t for me, and I wanted a more hands-on approach to medicine,” she says.

     

    Dr. Nalbandian did her residency at St. Elizabeth’s Medical Center in Boston, which is affiliated with Tufts University. As a resident, she served an academic coordinator and chief resident.

     

    A resident of Sherman Oaks, Gina continues to volunteer her expertise with the Special Olympics, Happy Feet (providing foot care at homeless shelters), and the Boston Marathon.

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