Surgery and Treatment for Brachymetararsia

Brachymetararsia is an unusually short toe that typically affects the fourth toe (next to the pinky). It can occur on any toe, however, as well as on multiple toes, and on both feet (referred to as brachymetapody). In more than 70% of cases, brachymetararsia affects the fourth toe on both feet.  

In this article we’ll use the terms brachymetararsia and short toe interchangeably.

Causes of Brachymetararsia

Short toe is caused by a growth disturbance—not a birth defect—that results in stunted bone development. The toe bone itself is normal length—it’s the longer metatarsal bone, which connects the toe to the foot’s arch, that is stunted.

Short Toe Can Be Embarrassing and Painful

An especially short toe is sometimes referred to as a “floating” toe. Brachymetararsia can cause significant embarrassment, especially in kids, adolescents, and young adults. Those with the condition often go out of their way to avoid showing their feet and may refuse to go barefoot around others. They are also frequently on the hunt for shoes that cover their embarrassing short toe(s).

Beyond appearance, brachymetararsia can be painful. The lack of proper support from one or more shortened toes can cause uneven weight distribution on the ball of the foot, resulting in pain. Trying to find shoes that fit properly, especially in cases where the toe rises upward, can be difficult, and ill-fitting shoes can also cause pain.

Non-Operative Treatments for Brachymetararsia

There are several non-surgical ways to decrease symptoms like pain and calluses that can develop from short toe. Among these simple treatments are:

Footwear Choices

• Wearing supportive shoes
• Wearing custom-made orthotic shoes
• Choosing shoes that have a wide toe box and flexible materials (such as cotton)
• Using an arch support insole

Other Treatments

• Avoiding specific activities/exercises that cause pain (e.g. jogging or jumping jacks)
• Anti-inflammatory medications (although these should not be used long-term)

Surgical Treatment for Brachymetararsia

When non-surgical treatments have been exhausted, or in cases where short toe causes significant embarrassment that reduces a person’s quality of life, surgery may be the best option.

There are several methods foot surgeons use to correct short toe. Today, the three primary methods include:

• One-Stage Lengthening: This procedure involves making a precise incision in the metatarsal bone and lengthening the bone using screws, wires, or sutures. This is Dr. Ravaei’s preferred procedure at 866-866-FEET, as it involves just one stage, and many patients are allowed to bear weight on the foot within a few weeks of surgery.
• Bone-Graft Lengthening: In this procedure a bone graft—usually from a different part of the body—is inserted into the short bone. There are limits to the amount of length that will result from this procedure, and the patient may be required to stay off his/her feet longer than with other procedures.
• Gradual Lengthening: This is essentially a bone-growing or bone-stretching procedure. It involves making a precise cut into the metatarsal bone and implanting an external fixator that will be used to stretch the bone apart over a time. The external fixator features a knob that the patient turns, which will gradually lengthen the bone. This gradual lengthening method requires ongoing care and monitoring until the desired toe length is achieved.

Where Is Surgery Performed?

Most brachymetararsia surgeries are performed in an outpatient setting, which means that patients can go home the same day. Depending on which method is chosen and the extent of the surgery, the anesthesia used may be local, regional, or general.

Local anesthesia is an injection given to numb part of the body in order to prevent any feelings of pain during surgery. Regional anesthesia involves numbing the trunk of a nerve and may have farther reaching effects than a local injection. Both types of anesthesia are often used with a sedative to reduce anxiety during the procedure. General anesthesia affects the whole body and generally induces loss of consciousness.

A patient’s foot specialist will determine which medical setting and anesthesia are the right choices.

Does Hardware Used in Toe Lengthening Surgery Remain in the Body?

Depending on which surgical method is chosen, some hardware may be permanent. For example, with the bone-graft surgery, plates and screws are usually permanent, although they can be removed later at the doctor’s discretion. The rods used to hold the bone steady as it grows during the gradual lengthening procedure is removed once the desired toe length is achieved.

What Are the Risks of Toe Lengthening Surgery?

There are risks with any surgery, including toe lengthening surgery. Your foot surgeon will review your health information and history thoroughly to weigh your risks and determine whether surgery is right for you. Risks with toe lengthening surgery can include (but are not necessarily limited to):

• Post-operative infection
• Pain (temporary or permanent)
• Blood clot
• Poor wound healing
• Nerve injury
• Hematoma
• Weakness in toe
• Hardware problems
• Scarring
• Poor bone healing

What to Expect After Surgery

Your foot doctor will help you understand what to expect after surgery. Some post-surgery pain and swelling are normal. Your doctor may have you wear a post-operative shoe and will ask you to keep your leg elevated for the first the couple days after surgery. You may be required to keep all weight off your foot for 5-8 weeks, depending on the procedure. You may be allowed to place some weight on your help, but you will need to use crutches or a wheelchair to get around. Healing generally takes 6-8 weeks.

Although there are risks with surgery and physical limitations for a period of time afterward, the benefits of toe-lengthening surgery including improved appearance, less pain, and better balance and coordination.

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