The metatarsals are five long bones which, along with other bones in the hindfoot and forefoot, connect the toes with the ankle. The metatarsals are numbered 1st, 2nd, 3rd, 4th and 5th (from the big toe to the pinky toe).
 
Brachymetatarsia is a condition which prevents a metatarsal bone from developing fully, or causes its growth plate to prematurely close. This results in the toe connected to that metatarsal being markedly shorter than the rest.

Why Brachymetatarsia Occurs

Brachymetatarsia most commonly occurs in the 4th metatarsal. It can be a congenital disorder, or it may be caused by trauma to the toe that occurred prior to the patient being fully grown.

The Symptoms of Brachymetatarsia

The most obvious symptom of Brachymetatarsia is an abnormally shorter toe in either, or both, feet. It typically presents around the age of 10. This may cause embarrassment as well as other symptoms including:

• Pain while walking
• A toe (or toes) that overlap another toe
• Irritation in the toe due to rubbing against footwear or surrounding toes
• Gait and/or balance difficulties
• Calluses on the bottom of the foot

Diagnosing and Treating Brachymetatarsia

After reviewing your medical history, performing a physical examination, and analyzing X-rays, your podiatrist may diagnose your issue as Brachymetatarsia.
 

Treatment will vary, depending on how much shorter the metatarsal is than the others, and how much discomfort the patient is experiencing.
 

• Padding may be used to avoid the toe rubbing against shoes and other toes.

• Custom orthotics can sometimes help distribute weight more evenly across the foot which can help reduce pain and improve balance while walking or running.

• Surgical intervention may be necessary in certain cases to lengthen the metatarsal either acutely or gradually.

• Acute lengthening is a single stage operation which may be used if the metatarsal needs to be lengthened by 15 mm or less. In this procedure, the bone is cut and a bone graft is inserted to lengthen it, which is held in place by a a low-profile plate. A surgical boot will need to be worn for a period of time after surgery, and regular footwear will gradually be introduced. It is not necessary for the plate to be removed, but it can be after the bone has fully healed.

• Gradual lengthening may be appropriate if the metatarsal needs to be lengthened more than 15mm. In this procedure, and external fixator will be surgically affixed to the affected toe, allowing the patient to walk and bear weight following surgery. After an initial healing period, the patient will make slight, prescribed adjustments to the fixator over time, to gradually stretch and lengthen the bone, and causing regenerate to grow and harden into healed bone. The fixator will then be surgically removed.

 
 
If you have any kind of deformity or discomfort in any of your toes, see your podiatrist as soon as possible to have the condition diagnosed and corrected.