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Updated: 6/15/2021

Brachymetatarsia

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  • summary
    • Brachymetatarsia is a rare congenital condition caused by premature epiphyseal closure of the metatarsals that presents with shortening of one or more metatarsals.
    • Diagnosis is made clinically with hypoplasia and shortening of most commonly the 4th metatarsal.
    • Treatment is observation with shoe modifications for mild cases. Surgical metatarsal lengthening may be indicated in patients with persistent pain with shoe wearing. 
  • Epidemiology
    • Demographics
      • female:male 25:1
    • Anatomic location
      • shortening of the fourth metatarsal is the most common
      • often bilateral
  • Etiology
    • Pathophysiology
      • cellular biology
        • due to premature epiphyseal closure of the metatarsals
    • Associated conditions
      • Down’s Syndrome
      • Turner’s Syndrome
      • Larsen’s Syndrome
      • Albright’s Syndrome
      • Diastrophic Dwarfism
  • Presentation
    • Symptoms
      • discomfort with shoe wearing
  • Imaging
    • Radiographs
      • recommended views
        • AP and lateral weight-bearing views
      • findings
        • shortening of the affected metatarsals
        • discontinued metatarsal parabola
  • Treatment
    • Nonoperative
      • shoe modifications
        • indications
          • first line of treatment and will generally will improve symptoms
        • technique
          • extra-depth or extra-wide shoes
          • taping and manipulative reduction attempts are ineffective
    • Operative
      • metatarsal lengthening
        • indications
          • if symptoms persist in the older child
      • amputation
        • very rarely indicated
          • if symptoms persist in the older child
      • extensor tenotomy and capsulotomy
        • indications
          • none: not likely to sufficiently correct the deformity
      • fusion
        • indications
          • result in complications and generally are not indicated.

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