Share this article on:

Treatment of Brachymetatarsia Involving the Great Toe

Kim, Hui, Taek, MD1,a; Hong, Sung, Min, MD1,b; Kim, In, Hee, MD1,c

doi: 10.2106/JBJS.OA.17.00046
Scientific Articles: PDF Only

Background: Brachymetatarsia is usually treated by lengthening the metatarsals, but excessive lengthening can be associated with complications. Our technique combines 1-stage step-cut lengthening of the first metatarsal with shortening and/or lengthening of the neighboring metatarsals and/or phalanges.

Methods: Twenty-four feet (15 patients) were treated for first-ray brachymetatarsia. Widely available commercial image-editing software was used to make a preoperative plan for each patient, with emphasis on the creation of a cosmetically satisfying toe-length arc with minimum shortening and lengthening of the affected metatarsals and proximal phalanges. Length gain and percentage increase were also recorded postoperatively. The American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scoring system was used for clinical evaluation.

Results: In all 24 feet, smooth parabolas were created at the level of the metatarsal heads and at the toe tips. All patients showed osseous union, and no complications were noted. However, most patients showed mildly restricted range of motion of the first metatarsophalangeal joint. The mean AOFAS score of the hallux significantly improved from 88.3 preoperatively to 98.1 at the latest follow-up (p < 0.001).

Conclusions: One-stage step-cut lengthening of the first metatarsal combined with shortening and/or lengthening of the adjacent metatarsal and phalangeal bones provides excellent cosmetic and functional results.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1Department of Orthopaedic Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea

E-mail address for H.T. Kim: kimht@pusan.ac.kr

E-mail address for S.M. Hong: SMHmin97412@gmail.com

E-mail address for I.H. Kim: soaringss@naver.com

Investigation performed at the Department of Orthopaedic Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea

Disclosure: There was no external source of funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A36).

© 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Journal of Bone and Joint Surgery, Incorporated.