Brachymetatarsia

Abstract

Brachymetatarsia involves a reduction in length of one or more metatarsals. The affected metatarsal is shortened by 5 mm or more, altering the normal metatarsal parabola. In addition to being an aesthetic deformity, it can present with pain due to transfer metatarsalgia. A possible association with genetic disorders needs to be investigated during clinical evaluation. Surgical treatment may involve a one-stage lengthening procedure or progressive distraction, each having its advantages and limitations.

Keywords: foot; metatarsal; osteogenesis; pediatrics.

Figure 1

Metatarsal formulas. (A) Index plus–minus foot (Roman foot). (B) Index minus foot (Morton’s foot type or Greek foot). (C) Index plus foot (Egyptian foot).

Figure 2

Clinical aspect of the foot of a 15-year-old girl with left fourth-ray brachymetatarsia.

Figure 3

Weight-bearing dorsoplantar foot X-ray of a 14-year-old girl with bilateral fourth-ray brachymetatarsia.

Figure 4

Lamm’s classification of brachymetatarsia. (A) Type A, metatarsal axial deficiency. (B) Type B, bowing. (C) Type C, incongruity in the metatarsophalangeal joint. These different types can be combined in one deformity.

Figure 5

A 12-year-old girl with third- and fourth-ray brachymetatarsia. (A) Preoperative clinical picture. (B) Preoperative dorsoplantar foot X-ray view. One-stage lengthening procedure with autologous bone graft interposition and K-wire fixation was performed. (C) Postoperative clinical picture; (D) Postoperative oblique foot X-ray view.

Figure 6

Intraoperative images of first pin insertion for the application of an external fixator for progressive distraction. (A) Skin incision of 2 mm. (B) Pin insertion perpendicular to the metatarsal. (C) Intraoperative X-ray images with the insertion point and final perpendicular position, perpendicular to the axis of the metatarsal.

Figure 7

Intraoperative images of sequential pin insertion. (A) The external fixator is used as a guide, fixed over the first pin inserted. (B) Distal pin insertion to establish the direction of the lengthening, in the axis of the fourth ray. (C) Two more pins are inserted, one in the proximal, and one in the distal clamp. (D) Intraoperative X-ray image with the external fixator applied.

Figure 8

Intraoperative images of percutaneous osteotomy of the metatarsal. (A) Percutaneous drilling. (B) Intraoperative X-ray with the complete osteotomy.

Figure 9

Images of a 12-year-old girl with bilateral brachymetatarsia. (A) preoperative dorsoplantar foot X-ray. (B) Immediately postoperative X-ray showing percutaneous osteotomy of the fourth metatarsal and external fixator positioning.

Figure 10

Images of a 12-year-old girl with bilateral brachymetatarsia (continuation). (A) Dorsoplantar foot x-ray after 10 days latency period and 30 days lengthening, showing distraction callus formation. (B) Dorsoplantar foot x-ray after 3 months postoperatively, after removal of the external fixator.

Figure 11

Images of clinical cases treated with lengthening by callotaxis. (A–B) Preoperative and postoperative clinical pictures of a 13-year-old girl with left fourth-ray brachymetatarsia. (C–D) Preoperative and postoperative clinical pictures of a 15-year-old girl with bilateral fourth-ray brachymetatarsia. Bilateral simultaneous progressive lengthening with an external fixator was performed.