What is Brachymetarsia?
This is a condition in which one of the metatarsals is congenitally short. It tends to affect women more than men and commonly involves the 4th metatarsal.
Patients often attend the clinic complaining that their 4th toe is too short and overlapping the third or 5th toe. Most patients that have Brachymetatarsia come to the Yorkshire Foot Hospital because they want improvement cosmetically and also want to be in less pain. There are also patients that would just like to fit in to a nice pair of shoes, There is no need to feel embarrassed as we are here to help.
What tests do I need?
Diagnosis can be made clinically by examination of the foot. X-rays are usually undertaken prior to any treatment to allow us to calculate how short the toe may appear. This ranges from 1-1.5cm.
What treatment is available?
If the foot is painful, orthotic insoles may be considered however most patients however want to attend the clinic to discuss surgical correction.
All surgical approaches involve lengthening the prominent toe or toes . At the YFH we prefer to undertake a one stage approach. This involves lengthening the toe and fitting the toe in to its new position with a titanium plate and screws. Once the toe or toes are stabilised in the corrected position.
The Brachymetatarsia procedure takes about one hour and can easily be undertaken on a day case basis under a local anaesthetic at The Yorkshire foot Hospital, we anaesthetise the nerve at the back of the knee which involves a single injection. The benefit of this is early discharge (within 1 hour of surgery) and up to 24hrs pain relief.
What is the recovery time?
Each patient is different,regarding recovery.
It takes at least 6 weeks for the bone to heal, and a little longer with a graft. Recovery is usually complete within 12 weeks. Most patients will require 12 weeks off work if the job involves standing for long periods. Individual cases will be discussed with the patient.
What are the complications?
All surgery has an element of risk, the risks would be explained by your consultant together with details which you can take home . Having surgery under local anaesthetic helps with the risk factor.
Specific risks include
- Poor bone healing- This is called delayed or non-union. Sometimes it just requires more time, occasionally bone stimulators or revision surgery is required.
- Mal-alignment- This is where the metatarsal heals in a poor position. Utilisation of the plate usually prevents this as it holds the bone in good position whilst it heals. Most mal-alignment occurs if the plate fails, often if the patient falls on the foot or puts too much weight through it in the early stages.
- Carefully following the post-operative instructions reduced the risk significantly.
Removal of the plate and screws- this may be undertaken if over time the plate loosens. Most often it can stay in place for ever, but it can be safely removed once the bone has healed if required.