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Toe Lengthening (Brachymetatarsia)

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What is toe lengthening? 

A short toe, also known as a floating toe, is a condition when there is a growth defect affecting a bone in the foot creating a short toe. Though it can affect all toes, the short fourth toe is most commonly affected. The toe itself is usually normal in length, but the bone the toe attaches to in the arch (metatarsal bone) is short.

Causes: Short toe is primarily hereditary (although it can be the result of trauma) and affects women more than males. Short toe can also occur in people affected with Downs Syndrome. When dealing with short toe, the metatarsal bone growth is stunted whereas the surrounding bone grow normally. It’s usually noticed in early childhood during bone development. It is possible to for all metatarsals to be affected by short toe, although the most common metatarsal is the fourth.

Sign & Symptoms: Due to the unappealing nature of short toe, people affected by it are almost always embarrassed and constantly hide their feet or avoid being barefoot around others. Depending on the severity of the short toe, pain could be present. Weight distribution of the ball of the foot is altered with a short toe and can cause pain and pressure calluses.

Diagnosis and Treatment: A podiatrist should be able to identify short toe via visual examination. Depending on the severity, there are several methods to surgically correct a short toe. In general, the surgery involves lengthening the metatarsal bone with either a bone cut, bone graft, and/or gradual lengthening.

The basis for toe lengthening involves restoring the length to the short bone. The three most common techniques for correcting short tow are as follows: 

  • Sliding Bone-cut Lengthening: Used for very mild cases, this procedure involves making an angled cut in the metatarsal bone to lengthen the bone by shifting the cut bones onto one another. This procedure achieves minimal length, making it the least performed of the three.
  • Bone-graft Lengthening: Ideal toe length is achieved by inserting a structural bone graft into the short bone. The bone graft size is determined on the length that is needed to complete the surgery. However, there is a limit to how much length can be obtained with this method as well. This method is only considered for toes that require less than one centimeter of lengthening, and only involves one toe. The bone graft is stabilized with a bone plate and screws that stay in the foot.
  • Brachymetatarsia External Fixator Lengthening: This is the most popular approach to achieving any amount of length to the bone. After making a precise bone cut intended to preserve the blood supply, an external fixator is attached to the bone segments to stretch the bone apart over a period the time. On their own, patients turn the device four times a day to slowly stretch the bone until the proper length is reached, and the remove the fixator.

Recovery: Recovery after brachymetatarsia surgery generally depends on the method of surgery performed, and how short the toe originally was. The general time frame for full recovery can range from six to eight weeks. Large defects where the external fixator is used can involve casting up to three months.

Dr. Ray Lopez

Minimally Invasive Bunion Surgery