This surgery is mainly for a condition called brachymetatarsia which usually affect the 4th toe
In fact, this condition is due to a short metatarsal (long bone to the toe) and not a short toe (although the toe can also be short, known as brachydactyly). In our experience, although it can affect any metatarsal, it is almost always the 4th toe and 4th metatarsal – see photos below.
We also do offer surgery for brachydactyly although safe lengthening of the toe is confined to around 5mm. See picture at the bottom of the page – see photo at the page bottom, where a small implant was used to lengthen the toe.
What does the surgery involve?
There are two main ways. Both involve surgically “breaking” the metatarsal. Either an external fixator (“Exfix”) device is fixed to the bone and kept on the outside of the foot for several months, where the metatarsal bone is gradually lengthened over this period. Alternatively, a bone graft can be inserted to lengthen the abnormally short metatarsal bone. The small bone graft is taken from the heel bone, so there is no risk of rejection of the graft.
In our practice we find the Exfix device has a higher risk of poor scarring, infection, failure of the procedure, and great difficulties with footwear during this period.
We prefer the patient to leave the theatre with the toe aligned and the graft in place. This is called the one-step procedure.