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Brachymetatarsia

The foot is an amazing part of the body, made up of dozens of bones, joints, muscles, and tissues. They allow us to stand and move, providing a stable structure for performing everyday activities like walking, running, jumping, etc. When our feet have problems, it can create problems for the rest of the body. Brachymetatarsia is a condition in which one or more of the five metatarsi bones in the foot is shorter than the rest, causing the attached toes to be much shorter than the others. This condition can affect a person’s ability to balance correctly and subsequently inhibit their ability to perform many everyday activities.

What is Brachymetatarsia?

The foot is made up of 26 different bones and 33 joints. This intricate combination of bones, joints, and muscle provide the foundation for our movement and independence. In the forefoot or the front of the foot, we find that there are five toes, called phalanges, attached to the front of five long bones called metatarsals. Brachymetatarsia is a condition in which one or more of these metatarsal bones is much shorter than the others.

Brachymetatarsia may affect more than one metatarsal bone on a foot and occasionally may even affect all five metatarsal, however, most often it is just the fourth metatarsal bone that is shorter than the others. Often, this makes the fourth toe appear much shorter than the other toes, or even look as if the fourth toe is raised while the third and fifth toes “fill in” underneath the short fifth toe. However, it is not actually the toe, or phalanges bone, that is short, but the metatarsal bone behind it. 

Brachymetatarsia can be visually evident, with the toes looking quite odd or unnatural. However, brachymetatarsia may also exist without visual evidence. Visual concerns are not generally what lead to a diagnosis or treatment of brachymetatarsia.

A shortened metatarsal bone can cause the toe not to contact the ground in the way that it should. In some patients, the affected toe is raised above the other toes, failing to touch the ground at all. When a toe fails to contact the ground, it cannot bear its share of a person’s weight, giving rise to a host of associated problems.

What Causes Brachymetatarsia?

Brachymetesarsia is caused by the metatarsal bone failing to grow to its proper length. This is most often caused by the growth plate in the metatarsal bone closing too early. Once a growth plate has closed, the bone associated with the growth plate can no longer grow. As the bones around the closed metatarsal growth plate continue to grow, the associate toe begins to look shorter and shorter by comparison. 

It is not always clear why the growth plate on a particular bone would close earlier than it should. Genetics are known to play a role, with several genetic conditions commonly related to brachymetatarsia. However, genetic causes are not always clear and trauma is thought to also play a role. 

Damage to the metatarsal bone may cause the growth plate to close early, permitting the surrounding metatarsal bones to outgrow the one with the closed growth plate. There are also several genetic conditions commonly associated with brachymetatarsia. These include Aneuploidic anomalies, Downs Syndrome, Turner Syndrom, Pseudohypoparathyroidism, Albright’s syndrome, and Diastrophic dysplasia. 

  • Aneuploidy Anomalies – When cells are missing or have an extra chromosome. Extra or missing chromosomes are the cause of some genetic disorders. 
  • Downs Syndrome – Downs Syndrome is a genetic condition in which an individual has an extra chromosome, a duplicate of chromosome 21. Downs syndrome is also called trisomy 21. Downs syndrome can cause a variety of developmental differences in the muscle tone and bone structure development of the patient.
  • Turner Syndrome – This genetic abnormality affects only women and can result in a variety of skeletal problems. 
  • Pseudohypoparathyroidism – An extremely rare condition in which the body fails to respond to the parathyroid hormone.
  • Albright’s Syndrome – Also called McCune-Albright syndrome, this disorder affects the growth of bones, skin, and some hormone-producing tissues. 
  • Diastrohpic Dysplasia – A disorder that affects the development of bones and cartilage.

Many times, the cause of brachymetatarsia is unknown. The effects, however, can be treated through a variety of methods including surgery, when necessary.

Very Short Fourth Toe

Brachymetatarsia may affect more than one metatarsal boon on a foot and occasionally may even affect all five metatarsals, however, most often it is just the fourth metatarsal bone that is shorter than the others. Often, this makes the fourth toe appear much shorter than the other toes, or even look as if the fourth toe is raised while the third and fifth toes “fill in” underneath the short fifth toe. However, it is not actually the toe, or phalanges bone, that is short, but the metatarsal bone behind it. 

A shortened metatarsal bone can cause the toe not to contact the ground in the way that it should. In some patients, the affected toe is raised above the other toes, failing to touch the ground at all. When a toe fails to contact the ground, it cannot bear its share of a person’s weight, giving rise to a host of associated problems.

Short Fourth Toe Meaning

Sometimes called a “floating toe,” a shortened fourth toe is the most frequent effect of brachymetatarsia. A short fourth toe may mean that a person has difficulty walking or balancing, as the shortened toe tends to raise or “float” above the third and fifth toes, not allowing it to properly participate in weight-bearing or balancing of the body. This imbalance can cause discomfort or even pain during walking. In extreme cases, brachymetatarsia can result in some restrictions in physical ability. 

Brachymetatarsia Surgery

When brachymetatarsia is causing you pain or discomfort, or if you have cosmetic concerns that cause you distress, brachymetatarsia surgery may be the answer. Patients often seek treatment for brachymetatarsia when:

  • They are in pain.
  • Brachymetatarsia interferes with walking or other activities.
  • Comfortable shoes are difficult to find.
  • They experience pain in the ball of the foot.
  • They have cosmetic concerns or experience psychological distress due to the appearance of brachymetatarsia. 

Toe Lengthening Surgery

Surgery can help extend the length of the toe bone, rather than the long bone known as the metatarsal. While this doesn’t repair all of the differences caused by brachymetatarsia, it can address many of the symptoms of the condition and repair the appearance of the foot. 

Toe lengthening surgery most often involves bone grafts being added to the short toe. This surgery can address mild to medium cases of brachymetatarsia. More advanced surgery may be required in severe cases of brachymetatarsia where additional bone length is needed to achieve the desired result.

Dr. Kelis is a podiatrist in Costa Mesa with more than 25 years of experience in treating conditions like brachymetatarsia. Call (714) 760-4944 today to schedule a consultation.

How To Fix Brachymetatarsia Without Surgery

There are several non-surgical treatments available to address the symptoms and concerns of brachymetatarsia. 

  • Good Shoes- Supportive shoes with good arch support can help distribute the weight of the body appropriately across the foot, relieving some of the pain and pressure caused by brachymetatarsia. 
  • Arch Support– Good arch support will help appropriately support the foot and distribute the weight, relieving many symptoms.
  • Wide Toe Box– Choosing a shoe with a wide toe box will allow the foot plenty of room to accommodate the different ways that the toes need to lay to find a comfortable position. 
  • Activity Modification– Some activities can be modified to accommodate the difficulties caused by a short toe. 
  • Anti-inflammatory Medications– To treat pain and discomfort, anti-inflammatory medications may be recommended.
  • Splints or Pads– Special splints or padding may be recommended by Dr. Kleis to aid in protecting the short toe and the rest of the foot.

Is Brachymetatarsia Hereditary?

Not all of the causes of brachymetatarsia are known. Sometimes it is caused by genetic abnormalities, but other times it is due to trauma in early childhood that causes the growth plate in the metatarsal bone to close too early. Some genetic disorders are inherited or hereditary and other times they just happen randomly. 

Some of the genetic disorders associated with brachymetatarsia are Aneuploidic anomalies, Downs Syndrome, Turner Syndrom, Pseudohypoparathyroidism, Albright’s syndrome, and dystrophic dysplasia.

Is Brachymetatarsia a Disability?

Most often the concerns with brachymetatarsia are mild pain or discomfort or cosmetic concerns. Brachymetatarsia seldom results in a significant disability of the sufferer. In some cases, however, brachymetatarsia can affect a person’s ability to balance well, reducing their ability to run or play sports as well as they might otherwise do. Orthotic shoes or inserts may help properly distribute an individual's weight and increase balance. Surgery can also be sued to help lengthen the bones of the toe, assisting the balance 

For those concerned with cosmetic presentation, surgery may be an option for lengthening the appearance of the affected toe. If you are suffering from brachymetatarsia, Dr. Kleis can help you find solutions that will allow you to live more fully. Treatment options for brachymetatarsia range from inserts to surgery. Dr. Kleis will perform a complete evaluation, taking your entire medical history into account, when diagnosing brachymetatarsia and determining the best treatment plan. 

Brachymetatarsia Treatment 

Dr. Kelis is a podiatrist in Costa Mesa with more than 25 years of experience in treating conditions like brachymetatarsia. Dr. Kleis will perform a complete evaluation, taking your entire medical history into account, when diagnosing brachymetatarsia and determining the best treatment plan. Treatment options for brachymetatarsia range from inserts to surgery.

Call Dr. Kleis today at (714) 760-4944 or book an appointment online

 

 

 

 

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