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Brachymetatarsia

Brachymetatarsia

Brachymetatarsia is a condition where one of the bones in the foot (metatarsal bone) is shorter than the others, causing a shortened toe.

Brachymetatarsia (short toes)

Brachymetatarsia is a condition where one of the bones in the foot (metatarsal bone) is shorter than the others, causing a shortened toe. It is usually congenital, which is present at birth but can also be acquired due to injury or infection.

The most common symptom of brachymetatarsia is a shortened toe, which can cause pain, discomfort, and difficulty fitting into shoes. In some cases, the condition may cause gait abnormalities and lead to other foot problems, such as calluses and corns, whereas for some people, it only has negative psychological impact without functional disability.

Causes

Brachymetatarsia is typically caused by a genetic or developmental abnormality that affects the growth and development of the metatarsal bones in the foot.

The exact cause of this condition is not always clear, but several factors may contribute to its development, including:

Genetic factors: Brachymetatarsia can be an inherited condition, passed down from parent to child through genes.

Hormonal imbalances: Abnormal levels of growth hormones or other hormones that affect bone growth and development can also contribute to brachymetatarsia.

Trauma: Injuries or trauma to the growth plate of the metatarsal bones may disrupt the normal growth of the metatarsal bones, leading to brachymetatarsia.

Infections: Certain infections, such as osteomyelitis (an infection of the bone) or septic arthritis (an infection of the joint), can also interfere with bone growth and development.

Radiation therapy: Exposure to radiation therapy, especially during childhood, can damage the growth plates of the bones and lead to brachymetatarsia.

Congenital disorders: Some congenital disorders, such as Turner syndrome or Down syndrome, can also be associated with brachymetatarsia.

It’s worth noting that in many cases, the exact cause of Brachymetatarsia is still unknown, and it may simply be a random developmental abnormality that occurs during fetal development.

Treatment

Conservative

The treatment of Brachymetatarsia depends on the severity of the condition and the symptoms that it may cause.

Treatment options may include:

Observation: In cases where the Brachymetatarsia is mild and not causing any symptoms, observation may be the best course of action.

Shoe modifications: Wearing shoes with a wider toe box or using padding or inserts can help to reduce pain and discomfort caused by the shortened toe.

Orthotic devices: Custom-made orthotic devices can be used to redistribute pressure on the foot and help improve foot function.

Physical therapy: Physical therapy can help to strengthen the muscles and improve the range of motion of the foot and ankle.

Surgical

Surgery is often the most effective treatment for Brachymetatarsia, especially in cases where the shortened toe is causing pain or difficulty walking.

Surgical treatment is usually recommended when conservative treatments have failed.

The surgery may involve lengthening the affected metatarsal bone using bone grafts or external devices. The specific surgical technique used will depend on the individual case and your surgeon will discuss the best option for you.

It is important to note that the treatment of Brachymetatarsia is highly individualized, and the best course of action will depend on a variety of factors, including the severity of the condition, the age and overall health of the patient, and the patient’s lifestyle and activity level.

Before & After Photos

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Appointment Information

Cost & Item Codes – Our fees are quoted on a case-by-case basis after your initial consultation with the surgeon as each patient presents differently and each surgery varies from patient to patient. Please book an initial consultation to discuss this further.

Scans – We recommend you have weight bearing x-rays prior to your appointment.

Telehealth – We may be able to offer an initial telehealth appointment if you live a distance away. Phone one of our friendly staff to see if this is possible for you. We may ask you to email some photos of your toes prior to your appointment.

Surgery Information

Do I need surgery? – Although your surgeon may recommend an operation to lengthen the affected metatarsal bone and reduce pain, it is your decision if you go ahead with the operation or not.

Duration – The operation usually takes between 60 minutes. This procedure is day surgery, and you can usually go home the same day.

Anaesthesia – Surgery can be performed under local anaesthesia, or general anaesthesia, depending on the surgeon’s and the patient’s preferences.

Medications – Your surgeon or anaesthetist may give you antibiotics during the operation to reduce the risk of infection.

Smoking – If you are a smoker, you need to stop the habit of smoking 4 weeks before your operation for normal healing and reduce postoperative complications. Nicotine is known to stop bones from healing.

Recovery Process

Patients must follow their surgeon’s instructions carefully during recovery to ensure proper healing and minimize the risk of complications.

In general, the following timelines can be expected:

Immediately after surgery: Go home and rest. Elevate your foot as often and as much as possible to reduce swelling. No weight bearing with foot/feet elevated, getting up for essential things only like toilet breaks.

  • Avoid smoking
  • Take pain medication as instructed

The first few days: You will need to rest and elevate your foot as much as possible. Patients must wear a moon boot to protect the foot and allow for proper healing. No weight bearing, with foot/feet elevated, getting up for essential things only like toilet breaks. Your wound needs to be kept dry until stitches are removed.

1-6 weeks: Depending on the type of surgery, you may need to wear the moon boot for up to 4-6 weeks – no weight bearing.

Your surgeon will advise when you can transfer out of the moon boot and start weight bearing.

Your wound needs to be kept dry until stitches are removed between 10-14 days after surgery.

Driving – Your surgeon will advise when you can start driving, usually 6-8 weeks after surgery.

YOU CANNOT DRIVE WHILE YOUR FOOT IS IN A MOON BOOT.

Do not drive while under the influence of narcotics and are confident about controlling your vehicle and always check with your doctor and insurance company first.

You can drive when you are full weight bearing without aids and given clearance from your surgeon.

Flying – Check with your surgeon on individual circumstances.

Return to Worksedentary – If you work at a desk with minimal time on your feet and you are able to elevate your foot/feet, you may be able to return to work between 2-4 weeks.

Return to Work active – If you have a physical job or are standing a lot and unable to elevate your foot/feet, you may not be able to return to work until 10-12 weeks.

Low impact exercise8-10 weeks as instructed and as tolerated eg slow walking, cycling, golf using caddie.

High impact exercise12 weeks as instructed and as tolerated eg fast walking, running, jumping, playing sport.

Full recovery can take up to 3-4 months.

Some possible complications following surgery include – pain, infection, bleeding, scarring, DVT.

Specific complications of surgery – Joint stiffness, Non-union.

Surgery

Surgery is often necessary for the treatment of brachymetatarsia, especially if the shortened toe is causing pain or difficulty walking.

The surgery aims to lengthen the affected metatarsal bone, which can be done in several ways, including:

The bone graft may be taken from the patient’s own body (autograft) or from a donor (allograft).

Some of the benefits of using a bone graft in brachymetatarsia surgery include:

  • Natural healing: Bone grafts provide a natural scaffold for the body to regenerate new bone tissue, which can lead to a more natural healing process.
  • Single Stage Surgery: Patients only undergo one surgery to lengthen metatarsals.
  • Lower risk of infection: Using a bone graft can reduce the risk of infection associated with other surgical techniques, such as distraction osteogenesis.
  • Improved stability: A bone graft can provide additional stability to the affected bone and may reduce the risk of complications or failure.
  • Long-term success: Bone grafts have a high success rate and can provide a long-term solution for treating brachymetatarsia. Bone grafting involves taking a piece of bone from another part of the body, such as the hip or leg or using an allograft and using it to lengthen the affected metatarsal bone. The graft is attached to the bone with metal screws or plates and left to heal over time. The procedure is chosen if the lengthening required is less than 10mm.

Distraction osteogenesis

This technique involves using an external device, such as a mini rail, to gradually lengthen the bone over several weeks or months. The device is attached to the bone with pins or wires and is adjusted regularly to stretch the bone gradually.

Some of the benefits of using distraction osteogenesis in brachymetatarsia surgery include:

  • Minimal scarring: Unlike traditional bone grafting techniques, distraction osteogenesis involves only tiny incisions, which can result in minimal scarring.
  • Reduced morbidity: The technique does not require bone tissue to be harvested from the patient’s own body, reducing the risk of morbidity and complications associated with a donor site.
  • Improved function: Distraction osteogenesis can improve foot function and reduce pain associated with brachymetatarsia.
  • Gradual lengthening: The technique allows for gradual lengthening of the affected bone, which can help to reduce the risk of complications and increase the likelihood of successful healing.
  • Greater Lengthening: The literature has demonstrated that distraction osteogenesis achieve a greater lengthening (more than 10mm) over bone graft technique (up to 10mm).

However, it is important to note that distraction osteogenesis is a complex surgical technique that requires specialized training and expertise. It can also be time-consuming, taking several months to achieve the desired lengthening. The risks and benefits of distraction osteogenesis should be carefully weighed and discussed with Dr Kim to determine the best treatment approach for the individual patient.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Podiatric Surgeon Dr Kim is the leading surgeon for Foot Surgery in Brisbane and Gold Coast, contact him today to see if you are a good candidate for surgery

No referral needed

Contact Us

A GP referral is welcome however it is not essential for your appointment

About

Dr Ji Soo Kim (Specialist Podiatric Surgeon) BPodM, DClinPod, FFPM RCPS(Glasg)

Book Appointment

Dr Kim has two offices, one located in Kelvin Grove, Brisbane. The other is in Southport, Gold Coast.

Please call 1300 522 096

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