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About Brachymetatarsia Reconstructive Surgery


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These are actual patient photos of Dr. Lee's Innovative One-Stage Brachymetatarsia Surgery.




Below are photos published from members of our Discussion Forum September, 2006.

These are one stage brachymetatarsia procedures


Brachymetatarsia, a condition characterized by an overlying toe on the foot is actually the result of a shortened long bone of the foot (metatarsal).  Usually, not seen at birth, the condition may gradually develop with time becoming evident between ages four and fifteen. Often this condition is emotionally traumatic and embarrassing to the individual preventing them from wearing any shoe gear that would expose this condition.

Dr. Lee's patients have enjoyed a wonderful physical transformation with the reconstructive cosmetic surgery for brachymetatarsia.  It has been equally gratifying for him to have performed the surgery and watched his patients gain freedom from the “bondage” they suffered for so many years.

Dr. Lee specializes in a one-stage lengthening procedure of the short metatarsal. Gradual lengthening is performed during the operative period. When the patient completes the 2-3 hour surgery the toe is at the full corrected length.

The advantages to his patients are:

  • No need to adjust the device. (Greatest potential for complications)

  • Reduced risk of infection.

  • Reduced risk of dislocation or abnormal position of the metatarsal bone.

  • Better cosmetic incision, because the external fixator can leave stretch marks and large circles.

  • No need for a bone graft from the hip bone. A safe, but often painful procedure.

The External Fixation Technique Disadvantage

Traditional brachymetatarsia surgery performed by most surgeons is done in a multiple-stage fashion where they use an external fixation device to gradually lengthen the bone over several weeks or months (depending on the amount of correction).  An external fixation device is a scaffolding which is placed on the outside of the foot.  The patient adjusts the length of the device to gradually stretch the bone over weeks to the desired length. Typical healing times range from 4-7 months in a cast with the external fixator protruding from the foot. (See Figure 1).


Figure 1

Because the fixation is outside the body there are a significant number of disadvantages to this technique:

  • Higher risk of infection due to exposed fixation device.

  • Higher risk of dislocation since the bone is soft for 4-6 months and the external fixation device is exposed to impact.

  • Longer disability

  • You, the patient has to adjust the device and care for the protruding pins at home.

Example of a short long bone of the foot from birth called brachymetatarsia.


When should I address birth defects?

The timing of addressing birth defects depends on the severity of the condition as well as the impact of the deformity on the development of normal physical activities. Some conditions such as Club Feet require immediate attention because of the it will impair normal walking which should begin between 9-15 months of life.  Other conditions such as a short long bone of the foot (brachymetatarsia- see photo above) do not impair physical activity and therefore can wait until more maturity.  However, conditions of obvious deformity do have a social impact at young ages. So, often, parent will choose to have something corrected sooner than later.

The best advice is to seek out a podiatric surgeon who has experience in pediatric deformities.  This professional can give you the best advice about when.


Are bunions a birth deformity?

Not necessarily.  Some children are born with "juvenile" bunions, however, this is quite rare. People who have bunions mey inherit their parents foot type. If their parent have had bunions then their offspring may be predisposed to better bunions more easily. However, the formation of bunions has to do with abnormal mechanics of the great toe joint which can be negatively affected by such factors as tight shoes, fallen arches or injury.





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David Lee, D.P.M., South West Foot Institute, Glendale & Phoenix  eMail: drlee@leepodiatry.com Office Phone: PLEASE CLICK HERE
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Last modified: August 26, 2014