BRACHYMETATARSIA

QUESTIONS AND ANSWERS

Can Brachymetatarsia Be Classified as a Disability?

Brachymetatarsia isn’t officially categorized as a disability, but its impact on daily life can be significant for some individuals. This condition involves one or more abnormally short metatarsal bones in the foot, which can lead to various challenges.

Many people experience discomfort that can interfere with their ability to wear typical footwear comfortably. Walking or participating in physical activities may also become difficult, ultimately affecting day-to-day functioning and possibly diminishing quality of life.

In situations where the condition results in considerable pain or restricts mobility, brachymetatarsia might be viewed as a physical impairment. It’s important for individuals experiencing severe symptoms to consult healthcare professionals. They can provide guidance on potential treatments or accommodations to help manage the condition effectively.

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.

Diagnosing Brachymetatarsia 

Diagnosing brachymetatarsia involves more than just identifying the physical anomaly. A comprehensive approach includes:

• Physical Examinations: A healthcare professional assesses the foot’s structure, looking for misalignment or discomfort.
• Imaging Tests: X-rays play a crucial role in accurately evaluating bone structure, helping to determine the condition’s severity.

Understanding the severity assists in planning a suitable treatment approach. Beyond the physical aspects, brachymetatarsia can significantly influence an individual’s lifestyle and emotional well-being. Those with the condition may find themselves restricted in activities they can comfortably engage in.

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

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 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 Immediate Care is Needed After Toe Lengthening Surgery?

Following toe lengthening surgery, the initial care phase focuses on rest and healing. The first two weeks are particularly crucial, as this is when the body begins its recovery process. Here’s what to consider during this period:

• Elevate Your Foot: Keeping your foot elevated can significantly reduce swelling and decrease discomfort. Aim to elevate it whenever you’re sitting or lying down.
• Pain Management: Your healthcare provider will design a personalized pain management plan to ensure you remain comfortable. Medications like acetaminophen or prescribed pain relievers may be used.
• Frequent Monitoring: Regular check-ups with your medical team are essential. They will assess your progress and make necessary adjustments to your care routine.
• Wound Care Instructions: You’ll receive specific guidelines on how to take care of the surgical site. This ensures it stays clean and reduces the risk of infection.
• Mobility Aids Usage: Post-surgery, you might need aids for mobility, such as crutches or specialized footwear. These tools help you move around without placing stress on the healing area.

Proper attention to these details enhances recovery, minimizes risks, and supports a smoother transition back to daily activities. Always follow your healthcare provider’s instructions closely for optimal outcomes.

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.

Immediate Post-Surgery Care

During the initial recovery period, it’s crucial to focus on rest and meticulous care. Elevating the foot as much as possible during the first two weeks helps reduce swelling and discomfort. Pain management is tailored to individual needs, ensuring patients remain as comfortable as possible. This phase often involves using temporary mobility aids like crutches or special footwear.

Follow-Up and Monitoring

Regular follow-up appointments are essential to track the healing process and make any necessary adjustments to the recovery plan. These appointments are typically scheduled frequently within the first few weeks and then more sporadically over the next six to twelve months. They provide an opportunity to address any concerns, assess physical therapy progress, and determine when it’s safe to return to normal activities.

Phased Recovery Timeline

Recovery is a phased process aimed at maximizing healing and restoring function. While individual timelines may vary, most patients can anticipate returning to light activities within 3 to 6 months, with a full return to all activities, including sports, by 12 months. By committing to a comprehensive recovery plan and addressing factors such as nutrition and lifestyle choices, patients can significantly improve their long-term outcomes.

Through dedication to recovery and proper guidance, the journey towards improved mobility and reduced pain is both achievable and rewarding.

The Importance of Follow-up Appointments After Toe Lengthening Surgery

After undergoing toe lengthening surgery, follow-up appointments play a vital role in ensuring a smooth recovery. Here’s why they are essential:

• Monitoring Progress: Regular check-ins with your healthcare provider help track how well your toes are healing. This is especially important in the first weeks post-surgery, when progress can be easily evaluated and compared to expected outcomes.
• Adjusting Pain Management: Initial discomfort is common, but your doctor can adjust your pain relief plan to keep you comfortable. Monitoring your pain levels allows for timely tweaks in medication or other interventions.
• Evaluating Physical Therapy: Physical therapy is often a part of the recovery plan, and follow-up visits allow your doctor to assess the effectiveness of your therapy regimen. They can make necessary adjustments to better support your healing and mobility.
• Addressing Concerns Promptly: Any worries or complications can be quickly addressed during these appointments. Catching issues early can prevent long-term setbacks, ensuring you remain on track towards full recovery.
• Deciding on Activity Resumption: Knowing when it’s safe to return to regular activities is crucial. Follow-up visits enable your doctor to determine the right time for you based on your unique healing process.

In essence, follow-up appointments bridge the gap between surgery and a successful recovery, ensuring personalized care and timely interventions.

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