Brachymetatarsia refers to a failure of the growth of the metatarsal bone in the foot resulting in a shortened appearance of the corresponding toe. The fourth toe is often affected. The condition is commonly bilateral meaning it is present in both feet and has been reported more commonly in females.

How common is it?

It is difficult to be certain what the true prevalence of Brachymetatarsia is. This is because most people with the condition do not come to medical attention. And most studies therefore only refer to those who have attended for treatment. The quoted incidence of 1 in 2000 is therefore likely to be an underestimate. Despite this, even at this rate we would expect over 30,000 people with the condition in the U.K

What are the symptoms?

The physical symptoms, when present, are due to abnormal load bearing.  The neighboring metatarsals (third or fifth) will end up taking more weight and can start to hurt. If the toe is sitting on top of the foot, it can also rub against shoes and be a source of discomfort.

Most cases are not symptomatic, and do not affect the function of the foot much. The degree of physical disability caused is therefore minimal. Having said that there is a significant psychosocial element to patients’ symptoms which can in some instances and cultures be very disabling. The appearance of the forefoot can result in significant restrictions on the type of shoes that patients can wear. This may mean that any open toe shoes, sandals, or flip-flops are avoided, and the patients will try and hide their foot from view. Participation in summer activities, swimming or other outdoor pursuits may therefore be impacted. This especially in the female adolescence period can have a profound effect on their wellbeing.

What causes the condition?

It is caused when the growth plate of the metatarsal closes earlier than it is supposed to. It results in a stunted growth of the bone. This occurs most commonly due to a genetic predisposition but can be because of damage to the growth plate from trauma, infection, or tumors.

Can Brachymetatarsia be treated?  

There is no medical management such as tablets or injections that can kick start the growth of the bone. The options are between managing any physical symptoms with appropriate footwear or to undergo surgery to lengthen the bone. Surgery can be very effective in relieving the physical symptoms but also to improve the appearance of the foot and thus help with the cosmesis and the psychosocial component of the condition.

What does surgery for Brachymetatarsia involve?

There are two common procedures used to surgically lengthen the short metatarsal. One option is a single stage lengthening when the bone is stretched out on the day of the operation and the gap filled with some form of bone graft; and the second option is to lengthen the bone gradually using an external fixator device that is attached onto the top of the foot. The patient will then turn a screw on the fixator several times a day and gradually lengthens the bone. Both procedures can be very effective, but each have their own problems. You can read more about the surgery for Brachymetatarsia on this site.

How much does the surgery cost?

Unfortunately, most publicly funded health systems such as the NHS and most health insurance companies do not recognise the psychosocial element of this condition as a disability and will only fund the procedure if there is evidence of significant pain or disability from the physical symptoms. Health insurance companies may also refuse to pay as this is considered a pre-existing condition in most instances.

This will mean that patients are often required to fund the treatment themselves. The costs vary according to the type of procedure planned and the clinic fees.

 

Ali Abbasian is a Consultant Orthopaedic Surgeon specialising in Foot and Ankle Surgery – click here to find out more  or get in touch