Brachymetatarsia or Short Metatarsal Brachymetatarsia or otherwise known as Morton's toe is a condition in which one of the five metatarsals (long bones of the foot) is noticeably short. This short bone results in a shortened toe. The main target of brachymetatarsia is the fourth toe of the foot and it can occur in both feet. This happens in 72% of cases. If it occurs in more than one toe, the condition is known as brachymetapody.
Brachymetatarsia often results from the early closure of the growth center of a metatarsal or metatarsals. Other metatarsals continue to grow, though. Because the toe is shortened, it cannot handle so much weight when standing. Therefore, the longer toes takes on a bigger load than the short one. This causes a thickened formation on the bottom of the toe. As the shorter toe moves upward, the longer toes try crowding under it causing pain and discomfort. There can also be an increase of calluses and pain under the surrounding area of the metatarsals. Along with the pain, many patients complain about the unattractive appearance of the toes and are ashamed to reveal their feet to anyone. This self-conscious feeling can lead to certain psychological issues such as depression.
Brachymetatarsia occurs 25 times more in females than in males with a rate of 1/1820 in females to a rate of 1/4586 in males. It is usually not apparent at birth but can become visually obvious at four years of age to 15 years of age.
For short-term relief of pain, patients with brachymetatarsia may use shoes that have a greater depth which allows the shortened toe more room to move. Because of the calluses that form, padding in the shoes is another to relieve discomfort.
There are three main surgical treatments used to correct the brachymetatarsia. The most common procedure to correct this anomaly is gradual lengthening. In this procedure the patient is taken to the operating room and a device is attached to his/her bone. The patient on a daily basis turns a knob on this device and lengthens the bone. After the bone is healed the patient is taken back to the operating room and the device is removed. The problem with this procedure is that it leaves a lengthy and unsightly scar and two operations are needed to fix this problem. The second procedure involves removing a bone graft from a different region of the body and adding that bone to the short bone. The problem with this procedure is that it requires two locations for the incision. Also, It may need for the patient to stay off his/her feet longer than other procedures. The last procedure, and the procedure that Dr. Ravaei prefers, is the one stage lengthening. In this procedure only one incision is made and the bone is lengthened with the use of screws, wires or sutures whichever Dr. Ravaei sees fit. Following this procedure the patient is sent home with crutches and advised to return for a follow up in one to five days. Most patients are allowed to bear weight in a few weeks. This procedure requires patients to be compliant and follow the doctor's orders. Not following these directions could lead to less than perfect results.