What is it?

So you thought that having a long toe could be problematic? So can having a short one! Brachymetatarsia or brachymetatarsal, is a congenital disorder attributed to a growth disturbance to one or more metatarsal bones in the foot, creating a short toe.  A short fourth toe is most common, though it could affect any toe.  The toe itself is usually normal length, but the bone the toe attaches to the arch (metatarsal bone), is short.  A really short toe can be described as a floating toe.

Human beings are endowed with five elongated bones to which the toes are attached. The metatarsal bones basically make up the front part of the arch. This congenital disorder is more common in women than men, with an estimated ratio of 1:20. Usually it tends to be noticed by age 7 years. By age 16, the growth plate is said to be closed. So if the toe has not grown anymore, you do have a problem on your hand.

 Causes

The hereditary factor is the most common cause, though trauma can play a role. While a short toe is a growth disturbance, it should NOT be viewed as a birth defect.  Brachymetatarsia may also occur in people with Psuedophypoparthyroidism or Downs syndrome.

Physiology of Brachymetatarsia

The problems caused by this condition are two-fold. One, there is the cosmetic aspect which can be very troubling especially for women as the shortened metatarsal bone thus causes a “relative” shortening of the toe that is attached to the shortened metatarsal bone. Two, there is the biomechanical consequence of brachymetatarsia, which can alter one’s gait and the shortened metatarsal may not contact the ground properly, or carry its share of the person’s body weight, resulting in pain and discomfort.

Sometimes it may even appear as if the fourth toe is raised up, with the third and fifth toes touching each other below it. It may also change the appearance and contour of the ball of the foot, making shoe selection difficult. It is easily diagnosed with an x-ray.

Treatment

Treatment for brachymetatarsia is limited. Conservative treatment involves wearing shoes with extra depth to allow more room for the shortened toe, or opting for corrective surgery.

 

When to Seek Short Toe Treatment

Common reasons patients seek treatment for brachymetatarsia are:

• -Pain
• -Interference with walking/activities
• -Difficulty fitting shoes
• -Worsening problem
• -Pain at the ball of the foot
• -Unsightly appearance
• -Psychological embarrassment

Non-operative Treatments for Short toe

Non-surgical methods for brachymetatarsia are aimed at decreasing symptoms (i.e., pain and/or calluses).

Simple options patients can utilise are:

• -Wearing supportive shoes with padding in them
• -Using orthotics or arch supports
• -Wearing shoes with a wide toe box
• -Modifying activities
• -Spot stretching your shoe

Short Toe Corrective Surgery

Depending on the severity of the problems, there are several methods to surgically correct a short toe. In general, the surgery involves lengthening the metatarsal bone.

One method is to add a bone graft to the short bone, allowing for lengthening in one stage. Another popular method is to grow the bone by gradually stretching it over the course of a few weeks. This is accomplished with a bone stretching device called an external fixator.

As there is no one universally applicable treatment, the other considerations apart from the severity of the affected toe, encompasses as well a patient’s gait pattern, activity level and shoe selection.

Following surgery, crutches would normally be used as all weight must be kept off the surgically repaired foot for 3 months.

In women who are required to wear dress attire on a regular basis, this condition can become a real issue. Surgery therefore really helps to improve one’s self esteem, ensure comfort, while allowing the freedom to show off your feet once more and not keep them in hiding.