In fact this condition is due to a short metatarsal (long bone to the toe) and not a short toe.  X-rays of the foot will almost always show the toe length to be normal although patients usually think that the toe is short.  In our experience, although it can affect any metatarsal, it is almost always the 4th toe and 4th metatarsal – see photos below.

How Does Brachymetatarsia Occur?

This is most frequently due to early arrest of the metatarsal bone growth so that it is left short in comparison with the others (premature closure of the epiphysis).  This can occur during pregnancy (intra-uterine) but also due to trauma or infection in childhood, and medical conditions such as poliomyelitis and Down’s syndrome.  In most cases, however, the patient is otherwise healthy.

Can it be treated?

Yes, but this will involve an operation, once all of the other metatarsals have stopped growing.

What does the surgery involve?

There are two main ways.  Both involve surgically “breaking” the metatarsal.  Then either an external fixator (exfix) device is fixed to the bone and kept on the outside of the foot for several weeks or months; or a bone graft is inserted to lengthen the bone, with a small piece of your own bone been taken from the heel bone.

In our practice we find the exfix devise cumbersome for patients with higher risks of scarring and infection and failure of the procedure.  We prefer the patient to leave the theatre with the toe aligned and the graft in place.  You will have to keep off the foot for a minimum of 6-weeks afterwards.  Overall recovery will take 6-12 months.

Photographs