Radiographic and Clinical Outcomes Following Single Stage Brachymetatarsia Correction of Greater Than or Equal to 15 mm.

Background: Brachymetatarsia is a shortening of one or more metatarsal bones. This condition can result in pedal complaints of metatarsalgia, calluses, toe deformities, and shoe irritation. When non-surgical treatments fail, surgical options include acute one-stage lengthening with a bone graft or gradual callus distraction with an external fixator. Acute correction is preferred for lengthening under 14 mm, while gradual methods are favored for corrections over 15 mm due to concerns of neurovascular injury and achieving incomplete correction. Gradual correction, however, can be associated with prolonged treatment, malalignment risk, pin tract infections, and patient compliance issues.

Purpose: The purpose of this study was to assess the clinical and radiographic outcomes of acute one-stage lengthening of 15 mm or more.

Methods: A retrospective review of patients who underwent acute brachymetatarsia correction of greater than or equal to 15 mm at a single institution was performed.

Results: Twenty-one patients (26 corrections) underwent an average lengthening of 17.6 mm, with a mean osseous consolidation time of 9.7 weeks. No cases of delayed union, malunion, nonunion, or neurovascular injury occurred. The most common complication was radiographic, asymptomatic fourth metatarsophalangeal joint arthritis (34.6%). Preoperative metatarsal parabola length averaged 12.7 mm and significantly decreased to 0.27 mm postoperatively (P < 0.001).

Conclusion: These findings support acute corrections exceeding 15 mm, challenging concerns of neurovascular injury with this approach.

Level of clinical evidence: IV.