A brachymetatarsia is a short metatarsal bone in the foot. Brachymetapody is the condition where multiple metatarsals are involved.

Symptoms of a brachymetatarsia are usually a “floating” toe which is shorter than others and does not seem to bear weight much when standing. The fourth metatarsal and toe is the most common one affected. The ball of the foot can give pain and callous formation on the bottom where the longer metatarsals take more of a load than the short one. As the shorter toe moves upward, the longer toes may try crowding under it. At early stages of brachymetatarsia, the pain isn’t as noticeable as the actual deformity. Over time there is usually a progression to the pain and callous underneath the nearby metatarsals.

Causes of a brachymetatarsia are due to a premature (early) closing of the growth plate in a metatarsal. Some are congenital (born with) and others are due to traumatic events. The exact cause of early growth plate closure of a metatarsal is not completely understood in many cases.

Prevention of a brachymetatarsia is not realistic as it is generally caused by heredity or trauma. The symptoms it produces can be prevented a little easier by following treatment your podiatrist advises.

Podiatric Care early after diagnosis may include orthotics or other adjustment of your footwear. By supporting the shorter metatarsal with an orthotic device the weight load can be more evenly dispersed over all five metatarsals and preventing the metatarsalgia type of pain with callous formation. For pain symptoms, anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce this swelling may be advised. Your podiatric physician may also recommend a surgical procedure to actually fix the structural problem of your foot.

Surgery to correct your foot structure may be the best option for you and can be preventative. The procedure is usually aimed at lengthening the shorter metatarsal and can involve bone grafts, bone external fixators, and/or internal fixation. A soft tissue procedure is also likely indicated as the shorter toe has developed a contracted (shortened) tendon that is attached to this toe. If the metatarsal is lengthened the tendon will likely also needed to be lengthened so the toe can “lay down”.

Post-operative Care and Risks of a bunionectomy depends on the exact surgery done. You may need a cast to protect you for a short time. Sometimes a soft bandage with a post-operative shoe is allowed. You should expect some pain following surgery as well as swelling. Especially for the first 48 hours you should keep your leg elevated and occasional ice placed over the area of surgery (about 20 minutes per hour). Surgical cuts are made through the skin so a scar is expected. If you are a keloid former, let your surgeon know. Surgical cuts are not only made through skin, but through other layers of tissue as well, a scar may form within your foot and lead to adhesions. For many brachymetatarsia procedures you will be required to keep all weight off of your foot for several weeks, typically 5-8 weeks depending on exact procedure. Your surgeon may allow you to place some weight on the heel. You may use crutches, a walker, or wheelchair to help you keep weight off of this foot. Healing time is typically 6-8 weeks for all bone cuts. This is influenced by many factors including your nutrition, circulation, and other medical conditions. If you are a smoker you can expect to take longer to heal. If your bone heals real slow it may be a delayed union, or if not at all a non-union. If you are required to keep pressure off of your foot your leg muscles are not being used as they were before surgery. This allows for slower movement of the blood through the leg vessels. Occasionally this can lead to a blood clot in the leg which can become life threatening. Hip and knee flexion and extension exercises as well as wiggling your toes gently can help prevent this from occurring. If you have a history of blood clots you should let your surgeon know.