BRACHYMETATARSIA

QUESTIONS AND ANSWERS

The Cause of Brachymetatarsia 

Genetics – Genetic conditions that often cause this abnormality are changes in the parathyroid hormone levels, Turner Syndrome, Down Syndrome, and Albright Syndrome.

Trauma – A child can also get a short toe if he/she had trauma to the toe before it finished growing. Trauma can close the growth plates before they become ready. And that can lead to stunted development of the digit.

Associated Problems 

Skeletal and Systemic Abnormalities 

Brachymetatarsia often relates to skeletal and systemic abnormalities such as Sickle cell anemia, Juvenile rheumatoid arthritis, Multiple epiphyseal dysplasias, Multiple hereditary exostoses, etc.

Polydactyly or syndactyly

Polydactyly or syndactyly can also appear along with a short toe. And you need to address this problem before or during the treatment of Brachymetatarsia. Patients with this problem often face difficulty in wearing shoes. They suffer pain and come up with aesthetic complaints as well.

Pain and Walking Difficulty 

Patients generally have complications in walking because of uneven weight distribution on foot. During normal walking, weight is evenly distributed from the fifth toe and then progressively to the remaining digits. And this happens because the toes are symmetrically longer from fifth to first.

So, if one of the digits is shorter than the previous one (for example, the fourth toe), this will disrupt the weight-sharing process on the feet. Consequently, the toes on both sides of the shortened digit will have to bear increased weight. And it causes pain and gait problems. Also, the shortened toe tends to rise upwards, making it difficult to wear shoes.

Brachymetatarsia Symptoms 

• A short toe is commonly associated with pain.
• It is almost always embarrassing.
• Individuals with short toes mostly prefer hiding their feet and avoid being barefoot.
• Children and young adults are often physiologically impacted.
• Patients prefer sitting higher up on their feet and can get problems with wearing shoes.
• Also, the weight distribution of the ball of the foot changes and can cause pain and calluses.

When to Seek Short-Toe Treatment

Common reasons your child with short toes might seek treatment for Brachymetatarsia are:

• Pain
• Problem with walking
• Difficulty fitting shoes
• Worsening problem
• Painful ball of the foot
• Unpleasant appearance
• Embarrassment

Brachymetatarsia Treatment 

Children with Brachymetatarsia commonly experience pain and difficulty wearing shoes. These problems usually affect their walking and activities and negatively impact their psychology regarding their foot’s appearance. Moreover, these complications are progressive as the foot grows and develops.

Now, while treating most foot deformities, there are both traditional and surgical options. The conventional treatments include supporting the elevated toe with wide, comfortable, and high-toe box shoes. Doctors also recommend avoiding activities that worsen the problem and aggravate the symptoms.

Non-operative Treatments

The Non-surgical methods for Brachymetatarsia focus on decreasing symptoms. The options are:

• Wearing shoes with a wide toe box
• Modifying activities
• Wearing supportive shoes
• Arch support
• Spot stretch shoes

Operative Options 

Surgical options are also available. Doctors use them to correct deformity, length abnormality of the metatarsal, and contracture of the toe.

Bone Graft

It is a simple technique in which doctors create a space in the metatarsal by cutting it. And then, they insert a structural bone graft into the place to adjust the length. Typically, experts use plates and screws to hold the metatarsal and graft in place when the bone heals. After the surgery, the patient needs to rest until the bone graft attaches and heals properly.

External Fixation

In this surgical approach, surgeons cut the bone and then stretch it out to length by using the bone callus distraction technique. It is also known as distraction osteogenesis/Callotasis and osteodistraction. Here, the expert makes a small cut on the affected metatarsal while securing the local blood supply.

Then they apply a mini-external fixator. After about seven days of the surgery, the patient will turn a nut on the device gradually, painlessly, to lengthen the metatarsal slowly. The lengthening occurs at about 1mm a day until they achieve the desired length.

What happens if Brachymetatarsia is left untreated?

Many individuals with Brachymetatarsia feel like their feet do not look aesthetically pleasing. They do not like the appearance of their feet. However, sometimes the concern is more than just aesthetic. It can cause severe pain and functional problems in the feet.

• So, leaving that imperfect toe untreated for a long time will cause pain and walking problems because of uneven body weight distribution on the toes. Your child will have problems with wearing shoes as well.
• It will change the way your child walks or conducts normal activities by causing pain, discomfort, or a feeling of unpleasant pressure on your child’s feet.
• You can also call us for we are specialists in children and their bodies and can quickly see if problems exist with the biomechanics of your child’s foot alignment as well. Both of these problems can cause pain.

Brachymetatarsia Surgery Recovery

Recovery after Brachymetatarsia surgery usually depends on the operative method and the length of shortening that needs to be fixed. The minimal recovery time is usually 6-8 weeks. When there are large defects or an external fixator is used, it sometimes needs casting for up to 3 months. Several factors that might prolong healing are smoking, age, poor nutritional status, and certain medical problems.

Conclusion

Just like any other operation, Brachymetatarsia Surgery also involves some risks. However, complications are not always your fault. To avoid unwanted issues such as blood clots, hematomas, bleeding, nerve injury, disability, stiffness, hardware problems, etc., you must consult a trusted orthopedic doctor like the ones at our practice, Medical City Children’s Orthopedics and Spine Specialists. Finally, Our doctors offer personalized treatment and urgent pediatric care services at all of our four locations — Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX.  If you notice any unusual physical or musculoskeletal symptoms in your child, don’t hesitate to contact us to avoid complications.

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Footnote:

National Institute of Health: Brachymetatarsia