All Your Questions About Brachymetatarsia Answered

Having a shorter toe than the rest of your toes can make you feel embarrassed. The truth is that the shorter toe resides higher up on the foot compared to its natural placement and can cause irritation and pain due to the development of callouses from the pressure of wearing shoes. The good news is that toe lengthening surgery is generally safe and straightforward. Keep reading for a full Q&A of how brachymetatarsia, a.k.a toe lengthening procedure, can alleviate pain and increase your quality of life.

What is brachymetatarsia (short toe)?

Brachymetatarsia, also known as short toe, is a rare congenital shortening of a toe resulting from the premature development and shortening of the metatarsal due to genetics or trauma.

Why is my 4th toe smaller than the rest?

Brachymetatarsia can affect any metatarsal bone but is most commonly associated with the 4th toe and typically affects both feet, especially in women. If brachymetatarsia occurs in more than one toe, the condition is known as brachymetapody.

What are the symptoms of brachymetatarsia?

Patients may suffer from pain on the ball of the foot, irritation of the shorter toe from friction and rubbing against the other toes or shoes, difficulty with gait and balance, and emotional distress during adolescence due to the cosmetic appearance of the toe.

What are non surgical ways to treat pain from brachymetatarsia?

Non surgical ways to treat pain from brachymetatarsia include the following:

• Shoe modifications, including the use of customized supportive shoes or shoes with wide toe boxes
• Custom orthotics
• Modification of activity
• Anti-inflammatory medications for pain and inflammation
• Toe pads to reduce irritation and friction of the affected toe

When should I seek short toe surgery?

Surgical intervention may be indicated in patients with persistent pain when walking or wearing shoes or with self-consciousness regarding the appearance of the toe as it relates to social activities. Surgery can improve function as well as cosmesis.

Am I a candidate for toe shortening surgery?

At Gotham Footcare, our foot and ankle specialists will perform a comprehensive assessment of your foot, consisting of both a physical and radiographic examination, to provide you with the best treatment option based on your individual needs.

Can you get surgery to make your toes longer?

Yes, there are many ways to make the toes longer. For example, lengthening may be achieved through a single-stage procedure consisting of cutting the short metatarsal and inserting a bone graft, or through a multi-stage procedure utilizing a mini-external fixator device to promote gradual bone growth and lengthening of the metatarsal.

How are short toes surgically treated?

The most common procedure to treat brachymetatarsia is Multi-Stage Gradual Lengthening with External Fixation. The external fixator device is attached to the shortened metatarsal, and the length of the device is progressively increased over time to stimulate bone growth until the optimum bone length is achieved.

My preferred surgical method is single-stage bone graft lengthening. Either a tricortical iliac crest bone graft or harvest bone graft can be obtained from your own body and used to lengthen the bone. Depending on the patient's case, the graft can then be fixated with K-wires, screws, or plates.

Is brachymetatarsia surgery considered cosmetic?

Yes and No. Brachymetatarsia surgery can significantly improve the cosmetic appearance of the foot. However, the primary goal of this procedure is to lengthen the metatarsal bone to eliminate pain and improve the function and balance of the foot.

Is toe lengthening surgery painful?

Depending on the surgical techniques, pain levels can vary from patient to patient but will be controlled with medications and close monitoring by your doctor.

What are the risks of toe lengthening surgery?

The risks of toe lengthening surgery include, but is not limited to, infection, persistent or increased pain, swelling, bleeding, formation of blood clots, poor wound healing, poor bone healing, neurovascular compromise, subluxation and stiffness of toe, hypertrophic scarring, and additional surgery being required.

How long does it take to recover from toe lengthening?

One-stage bone graft lengthening will take approximately 6 to 8 weeks. Post-operative healing time may be reduced through the use of a bone stimulator device. Multi-Stage Gradual Lengthening with External Fixation may take approximately 4 to 6 months until the optimal length of bone is achieved.

Is toe lengthening surgery covered by insurance?

Brachymetatarsia surgery may be covered by your medical insurance provider if deemed medically necessary by your surgeon. At Gotham Footcare, our surgical coordinator will contact your insurance carrier to determine your coverage and obtain prior authorization for your procedure. Please feel free to reach out to us with any questions or concerns that you may have.