Short Toe Surgery

If surgery is advised to lengthen your metatarsal (and realign toe position), your specialist will initially carry out an X-ray to assess which surgery is most appropriate for you.

This is a relatively common operation where extra length is achieved by inserting additional bone. This process of inserting additional bone is also known as a bone graft. The new bone need only be small, typically up to 1.5cm, the bone can be taken from another part of the body, such as the heel bone. Once the bone is inserted, the area is stabilised with a bone plate and screws that remain in the foot indefinitely. There is a limit to the additional length that can be achieved with this procedure. As a result this surgery is generally recommended when less than 1.5cm lengthening is required and only for one toe. You will need to take the first 4 – 6 weeks off from work following surgery. You may require a cast for the first 4 – 6 weeks, following this you may be transferred into an aircast boot for a further 2 – 4 weeks. Full bone healing takes up to three months. Swelling subsides over 6 – 12 months for the final result to be appreciated.
This procedure allows for a greater increase in bone length. The operation involves a precise cut to the bone that does not impede the blood supply followed by attachment of an external fixator device that will stretch the short bone over time. The external device allows you to slowly increase the bone length a little each day, after which the device is removed. The bone will gradually increase 1mm per day until the desired length is achieved. Once the bone has healed the fixation will be removed between 1 – 2 months postoperatively. Full bone healing takes up to 3 months. You will be in a specialised cast or boot for a period of up to 3 months. Larger deformities in bone length can be corrected using this technique.

Frequently Asked Questions

What is brachymetatarsia?

Brachymetatarsia is a short metatarsal affecting the feet. Usually it can affect one or more metatarsals. The most common metatarsal appears to be the fourth metatarsal and the patient presents with a short or elevated fourth toe. It appears to affect woman more than man.

What are the causes of brachymetatarsia?

The cause of brachymetatarsia is poorly understood. We do know that what tends to happen is that the metatarsal growth becomes stunted and there are theories around this possibly being related to injury but it is often also seen in family members and therefore could present a strong genetic link.

Can brachymetatarsia be fixed?

Brachymetatarsia can only be corrected via lengthening procedures of the metatarsal. This usually involves performing surgery using various techniques that are available.

What happens if brachymetatarsia goes untreated?

Patients often complain of the toe impinging against the shoes and causing irritation. I see patients on a regular basis that are embarrassed by the toe and develop psychological withdrawal from exposing their feet in public. You will often hear stories of them going to a beach and tucking their feet under the sand throughout their holiday. Some patients have never worn opened-toe shoes and others have never been comfortable in front of their partners to expose their feet. The impact appears to be wide and varied.

What are the treatment options for brachymetatarsia?

The treatment options have always been either to wear roomy deep shoes if one does not elect to have surgery. In the past all the techniques have involved amputation of the fourth toe or the affected toe which had generally a quick recovery period but in my opinion would lead to disfigurement. Surgical lengthening of the metatarsal is the ideal solution.
In terms of surgery there are two mainstream treatment options. The first one being a single-stage lengthening procedure which involves cutting and lengthening the bone and using a bone graft either from a patient or bone bank or artificial bone to interposition between the graft to maintain the length. Screws and plate specially designed for lengthening are used to stabilise the lengthened bone and the bone graft until healing has been achieved.
The other common technique is external fixator. The fixator is placed on the bone and held with specialist wires. The bone is cut and slowly lengthened over a few weeks. The fixation is then held in place until the bone healing has been achieved on X-rays.

How do you fix brachymetatarsia without surgery?

It is not possible to fix brachymetatarsia or lengthen the bone without surgery.

How long does it take to recover from a toe lengthening (brachymetatarsia) surgery?

The length of recovery typically depends on the type of procedure.
The single stage lengthening procedure would involve you to be in a cast for five to six weeks postoperatively with no weight on the foot until some bony consolidation is seen where the bone graft is placed to lengthen the bone. Following that patients typically will be in a walking boot for another four weeks. At 10 weeks postoperatively they are allowed to return to trainers. However, the swelling will continue to subside typically for up to six months and can even take up to a one year. The toe becomes stiff after the surgery and will require some therapy to try to regain the range of motion.
The external fixation technique requires you to be in a cast for approximately six weeks. The first three weeks are typically where the lengthening is taken place by daily rotation of the dials on the external fixator. The fixator is then held in place for anything up to three to six months depending on bone healing. Most people can have the fixator removed at three months but may well still be partially weightbearing on the foot. Complete healing can take approximately one year.

When can I walk after brachymetatarsia surgery?

Walking after brachymetatarsia surgery in both cases will not be allowed for first six weeks. Following this one can place weight but may still be in a protected boot for a prolonged period.

Is brachymetatarsia a birth defect?

There is still a debate as to whether it is or not. It could be a defect of the growing skeleton or may well be due to genetic predisposition.

What is the cost of brachymetatarsia surgery in the UK?

The London Foot & Ankle Surgery Clinic has arranged package prices for both single stage and external fixator techniques and they typically range from £7,000 to £10,000 per foot. Only one foot can be operated on at a time due to the level of immobilisation required in a cast postoperatively.

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