Dr. Gitlin has lectured nationally on the topic of Brachymetatarsia correction over the past 10 years. We have adopted new techniques based on extensive experience that keep incisions minimal ( usually only a few millimeters ) and all of our patients can walk on the surgical foot the day of surgery. Not only do we use those new techniques but we base our treatment on classic teachings of ilizarov ( the doctor who invented the technique of distraction osteogenesis - growing bone by stretching it out ). Techniques that have been tested and proven over the last 60 years in tens of thousands of cases. Dr. Gitlin has been translating journals and technical books from the Ilizarov hospital since his first trip there in 2002, gaining valuable insight on even the minute nuances that we now use for attain the most positive results for our patients.
Revision brachymetatarsia cases have been on the rise as well and many patients have been referred and treated here for this as well. Cases of incomplete bone formation or maturation, malunion, nonhealing or incomplete healing. Regenerate bone collapse with shortening of toe. As well as cases of fixator infection and stiff joints all fall into the realm of possible need for revision to get the best result. Please contact us for help if you need it.
Brachymetatarsia is a condition where one or more of the five long bones in the middle of the foot are abnormally short. This can result in the appearance of a significantly shortened toe that is associated with that short long bone. The long bones are called the metatarsals hence brachy which means short plus metatarsal equals short metatarsal. (usually looks like a short fourth toe but can be any toe ) Current medical knowledge tells us brachymetatarsia or brachymetatarsal is caused by trauma to the growth center of the bones during development, some theories suggest it may be a genetic link.
The condition is generally cosmetic but in many cases the patient cannot wear shoegear properly without discomfort and in other cases the ball of the foot may develop tenderness during walking from the altered bone architecture.
Treatments are limited for this condition, conservative treatment simply involves shoegear modification or padding. In most cases however this does not alleviate the problem. Surgical intervention is often necessary to correct the condition.
Generally these are divided into one stage procedures and gradual lengthening procedures. The one step lengthening involves in some cases shortening all the other adjacent metatarsals and elongating the brachymetatarsal by cutting and placing bone graft into it. As you can imagine this leaves excessive scarring to the foot and makes it difficult to achieve the exact length needed. It is very difficult to stretch out the tendons ligaments and surrounding soft tissues when the digit has been in that position from an early age.
This can also be increasingly painful since all of the nerves are stretched as well during the procedure. Also the patient is not allowed to weight bear on the limb for up to 3 months.
The gradual lengthening procedure involves using minimal incision surgery to cut the short metatarsal and to apply a titanium metal external fixator rail to the foot. This external scaffold sits on the outside of the foot and allows the doctor and patient to gradually make that metatarsal longer through distraction osteogenesis.
<click here to learn more about this> this is a technique where the bone is stretched out at a very particular speed that allows the bone to regenerate itself. There is no need for bone grafting.
Weight bearing in a special comfortable shoe is allowed and encouraged to promote faster and stronger bone healing. To learn more about the technique see the case presentation below. To see some other cases treated with the ilizarov distraction technique <click here!>
Our office also provides revisional surgery for failed brachymetatarsal surgery done elsewhere. Unfortunately these situations do occur at no fault of anyone since all people heal differently but we do have a variety of techniques to repair nonunions, regenerate fractures, malunions, toe joint stiffness, and joint contracture problems associated with brachymetatarsia correction.
Please contact our office here if you have any particular questions.