Brachymetatarsia - when a toe gets the short stick

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Brachymetatarsia is a congenital deformity of the foot caused by an abnormally short, usually the fourth, metatarsal. The result is that the toe at the end of the metatarsal is not ‘pushed’ through to the front section of the foot as it would be if the metatarsal had grown normally. This is why the affected toe appears to be considerably shorter than the surrounding toes and can even be crooked, although it usually has a normal length.

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Adem Erdogan, M.D.

In Germany, approximately 1 in 3000 people are affected (some 27,000 people) by this deformity, and women are 26 times more likely to be affected than men. The reason for this rare deformity is unknown.

Many patients suffer from the unusual appearance of their foot. In addition to the aesthetic issues, a large percentage of patients say that the deformity causes mental distress. Seventy-two percent (!) of my patients admit that they suffer from mental distress.

Signs of mental distress

Sufferers of Brachymetatarsia must often cope with:

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  • Low self-esteem
  • The feeling of being stigmatized
  • The feeling that they’re unattractive, which can result in sexual disorders. Thirty-four percent of my patients are ashamed of showing their feet to their partner.
  • Avoidance behavior: Brachymetatarsia patients avoid walking barefoot, swimming, and wearing open-toe shoes in public. Patients dread the idea of a seaside vacation, depriving not only themselves but also their partners of a very enjoyable experience.

The story told by brachymetatarsia patients is usually the same: when they’ve finally found the courage to see a doctor, they are usually told that nothing can be done and that they have to learn to live with it. In many cases, counseling is also recommended.

I have made the following observations:

  1. I don’t think that counseling makes much sense because the patient’s distress is caused by a correctable deformity rather than by a deformity that grew from an inner conflict. In other words, counseling does not remove the cause of the distress – the toe that is too short – and therefore does not help the patient.
  2. There are effective and modern surgical techniques to correct brachymetatarsia that deliver good to excellent results providing the healing process is uneventful.
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The most important surgical techniques are:

  • One-stage lengthening of the metatarsal bone using bone graft (autologous or artificial). This is a surgical procedure.
  • Callus distraction with an internal or external fixation device to lengthen the short metatarsal bone over a number of months.
  • Sagittal scarf osteotomy (to correct minor length differences).

The duration of postoperative care is usually between 6 and 12 weeks depending on the surgical technique selected. In order for the procedure to be successful, it must be carried out by an experienced surgeon, who should also have extensive experience with the above-mentioned, and sometimes complicated, procedures.

Conclusion:

Brachymetatarsia is not a twist of fate that one has to live with. The aesthetic issues and/or mental distress can be effectively corrected surgically. Patients can enjoy a normal life!

Adem Erdogan, Consultant surgeon
Certified foot surgeon by the Gesellschaft für Fußchirurgie eV (GFFC)/German Association for Foot Surgery
Aesthetic foot surgeon

www.adem-erdogan.de

Updated: 2015-10-23

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