Acute Correction of Congenital Brachymetatarsia in Adolescents and Young Adults

Introduction. Brachymetatarsia is a relatively rare abnormal shortening of metatarsal bone with female predominance. No consensus exists about the ideal surgical treatment for this condition while the two common strategies are gradual lengthening using external fixation and acute one stage lengthening. We describe the surgical technique of acute lengthening using iliac bone graft and report our results. Materials and Methods. Twelve patients (11 females, one male) with 14 short metatarsals were treated in our hospital over a 12-year period. The mean age was 17.4 years (range 14-28 years). Treatment protocol included metatarsal osteotomy, lengthening of extensor tendon and percutaneous tenotomy of the flexor tendon at the level of affected MP joint. Autologous iliac bone graft was inserted after elongation of the metatarsal by distraction through the osteotomy site and fixed using Kirshner wire. Results. Average metatarsal shortening was 13mm (range, 11-18 mm). The metatarsal length gained was an average of 12mm (range, 11-15 mm). Uneventful bone union was achieved in all cases after six weeks. At the end of treatment, the normal cascade of the metatarsal heads (metatarsal parabola) had been restored in 11 of the 14 metatarsals treated. There were no wound complications or pin tract infections around the wire. All but one patient were satisfied with the cosmetic appearance of the foot. Conclusion. Based on our experience, acute metatarsal lengthening using an iliac autugraft is a reliable and effective treatment method for congenital brachymetatarsia in adolescents and young adults.
Level of Evidence: Level IV Case series.