Brachymetatarsia: causes, symptom and treatments

Updated 2/4/2020

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 defect and is most often bilaterally (affects both feet) and usually involves the fourth metatarsal.

 

When the condition affects the first metatarsal it is referred to as Morton’s syndrome.

What causes brachymetatarsia?

Genetic causes of brachymetatarsia include:

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

 

A shortened metatarsal also be a result of trauma to the foot during development that results in premature closing of the growth plate. An x-ray can easily identify this condition.

 

Should I get treatment for brachymetatarsia?

Some people with fourth brachymetatarsia experience no symptoms. In those cases, no treatment is needed other than to modify foot gear to accommodate the toe defect.

 

While cosmetic factors may be involved, the most common reason to have a toe corrected is due to pain. When the brachymetatarsia affects the fourth toe, the toe can lift and crossover the third and fifth toes. This abnormal position of the toe can cause pressure and discomfort with certain foot gear, making finding comfortable shoes difficult. The pain can be exasperated with weight bearing activities.

 

When the affected toe does not lie flat and straight, it’s unable to adequately supporting your forefoot and, in turn, transfers weight to adjacent metatarsals. Also, certain cases of brachymetatarsia can alter the alignment in your foot resulting in faulty biomechanics. Both of these instances can lead to pain, discomfort and additional foot problems.

 

Treatment of brachymetatarsia (shortened toe)

Conservative management of brachymetatarsia include:

  • Custom orthotics and arch support
  • Modify activity
  • Wear supportive shoes with a wide toe box
  • Anti-inflammatory medication to reduce pain and inflammation

 

While non-surgical treatment don’t often successfully treat a short toe that is causing pain, there are several lengthening procedures to consider:

  • Bone graft inserted to increase the length of the metatarsal (Acute lengthening)
  • External fixator to gradually lengthen the toe as new bone growth fills the space (Gradual Lengthening)
  • A combination of acute lengthening and external fixation

 

Our foot and ankle surgeons will discuss which metatarsal lengthening surgical technique is best for your specific condition as well as what to expect during recovery.

 

Toe lengthening surgery recovery

Brachymetatarsia surgery recovery depends on the amount of toe correction needed and the type of surgery performed. Typical recovery time is 6-8 weeks. Cases with a large defect where gradual lengthening is used can require casting up to 3 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 amount of correction that was needed. Typically patients are non-weightbearing for a minimum of 6-8 weeks and can be up to 3 months.

 

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