What is it?

It’s a congenital disorder attributed to the abnormal shortening of the metatarsal bone. 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 disorder is more common in women than men.

Problems caused by this condition

 They are two-fold. One, there is the cosmetic aspect which can be very troubling. This is  especially so for women, as the shortened metatarsal bone causes a “relative” shortening of the toe in question. Two, there is the biomechanical consequence of brachymetatarsia, which can alter one’s gait (the way one walks), and in many cases, results in pain when walking.

Diagnosis
Because brachymetatarsia is usually idiopathic, or congenital in nature, at times it may also be caused by trauma to a metatarsal bone in its early stages of development. This would adversely affect the growth plate of the affected metatarsal, resulting in a shortened bone. It has also been associated with more systemic congenital disorders.

The deformity is easily diagnosed by visual inspection and x-ray of the affected foot. When foot specialists examine an x-ray of a foot, one of the things we look for, is normal formation by the heads of the metatarsal bones. In most people, the second metatarsal bone is the longest, with gradual shortening of the remaining bones. In brachymetatarsia, one of the metatarsal bones will be excessively short, compared to the other metatarsal bones. The fourth metatarsal bone tends to be affected in the majority of cases.

With this condition, there is no one universally applicable treatment. Consequently, it depends on the nature and severity of the affected metatarsal bone, as well as other considerations such as a patient’s gait pattern, activity level, and shoe selection. In women who are required to wear dress attire on a regular basis, it can become a real issue.

Treatment

Non-surgical – It revolves around prescribing shoes with extra depth, to relieve the toe from the pressure and friction, to which it gets exposed from the top of the shoe. Customised orthotics is yet another option available to patients. It helps to relieve the condition, given one of the problems with a shortened metatarsal, is that it does not do its fair share of picking up body weight. As a person moves around, it may result in added pressure on the adjacent metatarsals. A prescription orthotic, will generally have either a metatarsal pad or bar built into it, to take the excessive pressure off the adjacent metatarsals, and aid in more evenly distributing body weight, across the ball of the foot.

Surgical – These procedures are highly specialised in nature. The goal of surgery is to lengthen the shortened metatarsal bone (and the surrounding soft tissue). Gradual distraction osteotomy is a procedure where the shortened bone is cut straight across. Applied to either side of this bone cut, is an external fixator device, which as the name implies, is located outside the foot. Over a period of time, determined by the lengthening desired, the metatarsal bone is gradually stretched until the desired length is achieved. Depending on the amount of lengthening, a bone graft may also be inserted in order to maintain the desired length. This procedure would not be attempted on those who have an exceptionally short metatarsal, as there is only so much you can lengthen the metatarsal bone. The objective of this surgery, is to ensure metatarsal bones bear equal body weight, as well as to better align the toes. This procedure is not without potential complications; the two most common being surgical failure and infection. 

Additionally, if the bone is over corrected, mainly by too much plantarflexion or dorsiflexion, it will still not adequately pick up its share of body weight, and may also adversely affect the alignment of the toe at the end of that metatarsal. This would cause the toe to either bend upwards or downwards, in an excessive manner. It appears however, that most cases of brachymetatarsia require no treatment, or at the very least, conservative care.

Your feet mirror your general health . . . cherish them!