Brachymetatarsia Case Study

This is a 40 year old female who has a history of 4th digit hammertoe for many years. She underwent surgical intervention 7 years ago with hammertoe repair and shortening osteotomy of the 4th metatarsal. Unfortunately, the 4th metatarsal was shortened and plantarflexed excessively resulting in a floppy 4th toe and pain in the ball of the foot specifically on the 4th metatarsal head region. 

She was treated conservatively for a few years with custom orthotics and shoe gear modification. Deformity worsened over time and pain was limiting her ability to perform activities of daily living. Surgery was then recommended as an attempt to alleviate pain due to the deformity. 

There are multiple ways of approaching this deformity. Single stage deformity correction was chosen for this patient as the length of the 4th metatarsal that needed to be increased was less than 1 cm. 4th digit hammer toe was also repaired in conjunction with the lengthening procedure. The lengthening procedure requires a bone cut in the proximal bone and a bone graft is utilized to increase the length. 

Postoperatively the patient is placed in a soft cast and follows a non weight bearing protocol. Sutures are removed on week 3. Partial weight bearing is resumed at week 6 and the patient is expected to return to full activity with physical therapy at week 8.