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Ortiz-Romero M, Fernández-Garzón Á, Caceres-Matos R, García de la Peña R, Rayo-Perez AM, Gordillo-Fernández LM. One-Stage Technique with Calcaneal Graft for the Treatment of Brachymetatarsia: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:497. [PMID: 40142308 PMCID: PMC11943616 DOI: 10.3390/medicina61030497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 03/05/2025] [Accepted: 03/07/2025] [Indexed: 03/28/2025]
Abstract
Brachymetatarsia is a rare congenital anomaly characterized by the shortening of one or more metatarsals, which can lead to functional impairment, pain, and aesthetic concerns. This case report describes a 17-year-old female patient with brachymetatarsia affecting the third and fourth metatarsals of the right foot, which was unresponsive to conservative treatment and caused persistent pain while standing. To address this condition, a single-stage surgical approach was performed using an autologous calcaneal bone graft to lengthen the affected metatarsals. Additionally, the second and fifth metatarsals were shortened to restore a physiological metatarsal parabola and resolve chronic metatarsalgia. The procedure resulted in complete correction of the metatarsal parabola, full resolution of metatarsal pain, and satisfactory functional recovery. The use of an autologous calcaneal graft proved to be an effective and reliable surgical option due to its cortico-cancellous composition, high osteogenic potential, and low antigenicity. This case highlights the advantages of autologous bone grafting as a valuable technique in the surgical management of brachymetatarsia.
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Affiliation(s)
- Mercedes Ortiz-Romero
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (M.O.-R.); (R.G.d.l.P.); (A.M.R.-P.); (L.M.G.-F.)
| | | | - Rocío Caceres-Matos
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Research Group CTS-1050: Complex Care, Chronicity and Health Outcomes, 41009 Seville, Spain;
| | - Raquel García de la Peña
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (M.O.-R.); (R.G.d.l.P.); (A.M.R.-P.); (L.M.G.-F.)
| | - Ana M. Rayo-Perez
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (M.O.-R.); (R.G.d.l.P.); (A.M.R.-P.); (L.M.G.-F.)
| | - Luis M. Gordillo-Fernández
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain; (M.O.-R.); (R.G.d.l.P.); (A.M.R.-P.); (L.M.G.-F.)
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Li X, Gu J, Wu Y, Wang Y, Gong X, Sun N, Li Y, Lai L, Li W, Li H, Yang X, He X, Du H. Treatment of Fourth Metatarsal Brachymetatarsia Using Distraction Osteogenesis with External Fixator: Surgical Techniques, Outcomes and Complications. Orthop Surg 2024; 16:2148-2156. [PMID: 39187992 PMCID: PMC11572578 DOI: 10.1111/os.14204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024] Open
Abstract
OBJECTIVE Surgical technique in distraction osteogenesis for the treatment of brachymetatarsia can influence the final prognosis. However, there are currently no standardized guidelines for surgical procedures and complication management. The aim of this study is to investigate the effect of bone lengthening with external fixation by minimally invasive osteotomy based on Ilizarov technique in the treatment of congenital brachymetatarsia. METHODS A retrospective study was conducted on patients with congenital brachymetatarsia treated by metatarsal lengthening, from June 2017 to December 2020. There were 11 patients with 17 shorted fourth metatarsals, including 10 females and 1 male, with age of 24.6 ± 4.5 years (16-31 years). Six patients were bilaterally involved. Orthofix external fixator mini track was installed through dorsal approach and the fourth MTP joints were temporarily fixed by Kirschner wire. Bone lengthening was performed after a minimally invasive osteotomy at the proximal metatarsals. American Orthopedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal (MTP-IP) scores, metatarsal length, complications were recorded. Statistical comparison was performed using the paired t-student test for pre- and postoperative AOFAS MTP-IP scores. RESULTS Patients were followed up for 55 ± 10.8 months. The mean length of the fourth metatarsal bone was 49.9 ± 2.9 mm preoperatively. The mean metatarsal shortage was 18.8 ± 3.1 mm. The mean lengthening achieved was 19.8 ± 3.3 mm, with a lengthening ratio of 39.7% ± 6.6%. The lengthened callus ossified completely at 3-4 months after operation. All patients were satisfied with the results of lengthening. The AOFAS scores were improved significantly from 83.7 ± 4.2 preoperatively to 93.2 ± 2.7 postoperatively (t = -10.27, p < 0.001). One patient with traumatic metatarsophalangeal joint subluxation was treated by joint reduction and Kirschner wire fixation. One patient had metatarsophalangeal joint release and Kirschner wire fixation due to flexion contracture. Pin tract infections were controlled by wound care and antibiotics in 6 patients. All patients had no nonunion, necrosis of toes, and sensory disturbance of toes. CONCLUSION Metatarsal lengthening by minimally invasive osteotomy with external fixator had satisfactory results in the treatment of congenital brachymetatarsia.
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Affiliation(s)
- Xing Li
- Department of Foot and Ankle SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Jianming Gu
- Department of Adult Joint Reconstructive SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Yong Wu
- Department of Foot and Ankle SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Yan Wang
- Department of Foot and Ankle SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Xiaofeng Gong
- Department of Foot and Ankle SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Ning Sun
- Department of Foot and Ankle SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Ying Li
- Department of Foot and Ankle SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Liangpeng Lai
- Department of Foot and Ankle SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Wenjing Li
- Department of Foot and Ankle SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Heng Li
- Department of Foot and Ankle SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Xiaosong Yang
- Department of Foot and Ankle SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
| | - Xiaotian He
- Department of Foot and Ankle SurgeryBeijing Da Wang Lu Emergency HospitalBeijingChina
| | - Hui Du
- Department of Foot and Ankle SurgeryBeijing Jishuitan Hospital, Capital Medical UniversityBeijingChina
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Arceri A, Mazzotti A, Zielli SO, Artioli E, Viroli G, Traversari M, Ruffilli A, Faldini C. What's the evidence on surgical treatment for congenital brachymetatarsia: A systematic review and meta-analysis. J Orthop 2024; 49:107-116. [PMID: 38094980 PMCID: PMC10714338 DOI: 10.1016/j.jor.2023.11.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 03/03/2025] Open
Abstract
Purpose Brachymetatarsia is marked by the shortened length of one or more metatarsal bones. Several operative options have been suggested without demonstrating the superiority of one treatment over another. This study aims to assess the main available treatment, bone lengthening achieved, clinical outcomes, and complications pertaining to congenital brachymetatarsia interventions. Methods A literature search of PubMed, Embase, Scopus, and Cochrane databases was performed according to PRISMA guidelines. Result After the screening process, 13 articles were included in the review. Brachymetatarsia mainly occurs in females at a ratio of 14.8:1, and bilateral involvement in 25.8 % of cases. The fourth metatarsal is most affected, followed by the first metatarsal. The main surgical procedures are one-stage approach which results in limited length gain but fewer complications, and gradual lengthening which achieves greater length but has a higher complication rate, including metatarsophalangeal or interphalangeal subluxation, fractures, and infections. The first metatarsal reported better values concerning lengthening rate and healing index compared to fourth metatarsal, while no differences were observed in distraction rates or clinical outcomes. More complications, such as stiffness, fractures, and cavus foot were associated with first metatarsal lengthening. Conclusions It is not possible to identify a gold standard technique for addressing this condition. The two predominant surgical techniques bear advantages and drawbacks. A judicious case-by-case assessment is mandatory to determine the optimal surgical approach. Exploring the combination of techniques could be promise in mitigating the limitations associated with the main two methods and achieving better forefoot balance. Level of evidence Level II, systematic review.
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Affiliation(s)
- Alberto Arceri
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Antonio Mazzotti
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123, Bologna, Italy
| | - Simone Ottavio Zielli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Elena Artioli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Giovanni Viroli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Matteo Traversari
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Alberto Ruffilli
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123, Bologna, Italy
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Siddiqui NA, Mateen S, Thomas MA, Millonig KJ. Comparing Outcomes of Acute Versus Gradual Surgical Correction in Brachymetatarsia. J Foot Ankle Surg 2024; 63:281-285. [PMID: 38061623 DOI: 10.1053/j.jfas.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/27/2023] [Accepted: 11/28/2023] [Indexed: 12/25/2023]
Abstract
Brachymetatarsia consists of a shortened metatarsal resulting in a shorter toe. Pain with shoe wear and cosmetic concerns are the main reasons for surgical intervention. Surgical techniques to increase metatarsal length include acute lengthening with interpositional bone grafting or gradual lengthening with callus distraction. We performed a retrospective cohort study for 1 surgeon's patients at 1 institution over 10 years. Twenty-nine feet in 22 patients met inclusion criteria for acute correction; 16 feet in 11 patients were included for gradual correction. Mean ages were 26.3 ± 12.1 and 27 ± 10.8 in the acute and gradual groups, respectively (p = .79). Most patients were female: 95.4% of acute cases and 90.1% of gradual cases. Most involved lengthening the fourth metatarsal: 86.7% and 100% of acute and gradual groups, respectively (p = .54). Correction obtained amounted to 14.4 ± 2.97 mm (range, 10-22 mm) in acute cases and 14.8 ± 2.39 mm (range, 10-20 mm) in gradual cases (p = .81). The mean percent increase in metatarsal length was 21.1 ± 14% for acute and 22.6 ± 12.4% for gradual (p = .72). Mean consolidation was 8.9 ± 2.51 weeks for acute and 21.4 ± 10.8 weeks for gradual (p = <.001). Nonunions were most common in the gradual group (37.5%) with need for more revisional surgery (43.5%) compared with the acute group; both were statistically significant. We conclude that acute brachymetatarsia correction can obtain correction similar to the gradual technique with fewer postoperative complications and less osseous consolidation time.
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Affiliation(s)
- Noman A Siddiqui
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
| | - Sara Mateen
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Michael A Thomas
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Kelsey J Millonig
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
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Hung WC, Chen CH, Lin CH, Chen TY, Lo SP. Subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia: A consecutive case series and literature review. Foot Ankle Surg 2023; 29:86-89. [PMID: 36328920 DOI: 10.1016/j.fas.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/30/2022] [Accepted: 10/19/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study examined the functional and clinical outcomes of subacute two stage metatarsal lengthening with gradual distraction for brachymetatarsia. This technique was developed to overcome the disadvantages of one-stage metatarsal lengthening and gradual distraction. METHODS Four feet of three patients with congenital brachymetatarsia underwent subacute two stage metatarsal lengthening with gradual distraction. Pain, function, and alignment were assessed preoperatively and at follow-ups using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal-interphalangeal scale, and any complications were recorded. RESULTS The patients were followed up for a mean of 18.1 ± 6.9 (range, 12.6-28.1) months. The mean metatarsal length gain was 15.2 ± 3.2 (range, 12.1-18.5) mm, and the corresponding percent increase was 32.5 % ± 7.0 % (range, 25.7-41.1 %). The mean AOFAS score (0-100) was 97.5 ± 5.0 at the final follow-up. The external fixator index was 10.2 ± 1.5 (range, 8.1-11.6) days/cm. None of the patients experienced metatarsophalangeal stiffness, subluxation or dislocation of the metatarsophalangeal joint, loss of correction, pin tract infection, delayed union, nonunion, or angular deformities. CONCLUSION Subacute two stage metatarsal lengthening with gradual distraction is a reliable alternative treatment for brachymetatarsia.
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Affiliation(s)
- Wei-Chen Hung
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chun-Ho Chen
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chang-Hao Lin
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Tzu-Yin Chen
- Department of Physical Therapy, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Sheng-Pin Lo
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
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Toporowski G, Thiesen R, Gosheger G, Roedl R, Frommer A, Laufer A, Rölfing JD, Vogt B. Callus distraction for brachymetatarsia - A comparison between an internal device and the external fixator. Foot Ankle Surg 2022; 28:1220-1228. [PMID: 35525786 DOI: 10.1016/j.fas.2022.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/15/2022] [Accepted: 04/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Symptomatic patients with severe brachymetatarsia are commonly treated with callus distraction using external mini-fixator (EF) or internal device (ID). This study points out advantages and limitations of both methods comparing clinical and radiographical parameters. METHODS Retrospective analysis of 21 metatarsal bones in twelve patients. Twelve metatarsals were treated with ID (Genos Mini), nine with EF (MiniRail). RESULTS Mean lengthening distance was 17.3 mm using EF and 11.7 mm using ID (p = 0.016). Adverse results were observed in 89% of metatarsals treated with EF and in 33% treated with ID (p = 0.011). Postoperative surgical intervention was required in 33% using EF compared to 0% using ID (p = 0.031). Mean total German Foot Function Index (FFI-T) improved from 49 to 33 using EF and from 47 to 22 using ID (p < 0.001). CONCLUSION CD is a reliable surgical treatment for BMT. Surgeons should be aware of implant-related advantages and complications when counseling patients about treatment options.
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Affiliation(s)
- Gregor Toporowski
- General Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany; Children's Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
| | - Roman Thiesen
- General Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany; Children's Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Georg Gosheger
- General Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Robert Roedl
- Children's Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Adrien Frommer
- General Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany; Children's Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Andrea Laufer
- General Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany; Children's Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Jan Duedal Rölfing
- Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark.
| | - Bjoern Vogt
- Children's Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Brachymetatarsia: Surgical Management, Case Report, and Literature Review. Case Rep Orthop 2022; 2022:8253096. [PMID: 35310144 PMCID: PMC8930250 DOI: 10.1155/2022/8253096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Brachymetatarsia is defined by an abnormal shortening of the metatarsal bone. This rare condition is mostly primary and congenital. Consequences of this malformation are both esthetic and functional, due to pain and mechanical problems in the forefoot. Surgical management is an important part of patient care. There are two main options: gradual lengthening by progressive callotosis distraction using an external fixator and one stage lengthening using bone graft and osteotomy of the bone. This review presents two cases using the one stage lengthening surgical management method. We also discuss some reports in the literature with the aim to compare the advantages and disadvantages of the two surgical methods. Literature concerning the surgical management of brachymetatarsia was identified using the PubMed and Google Scholar databases. Patient Presentation. We describe two female patients aged 20 and 26 years who underwent one stage lengthening surgery of the fourth toe with isolated brachymetatarsia using an iliac bone graft and internal fixator plate. The two patients had a lengthening of around 10 mm after postoperative evaluation. No skin complications were noted, but one of the patients reported flexor stiffness after surgery. Concerning the functional and cosmetic aspects, the two patients are satisfied with the management. Conclusions In the literature, one stage lengthening seems to be the most favorable option for the care of brachymetatarsia. Studies show a short healing time and fewer complications like infection, stiffness, malalignment, and malunion. Some reviews note the utility of the gradual lengthening of severe brachymetatarsia when a longer lengthening is necessary. There is no definite consensus concerning the management of brachymetatarsia.
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Chaparro F, Espinoza R, Pellegrini MJ, Carcuro G, Ortiz C. One-Stage Lengthening and Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Brachymetatarsia. Foot Ankle Int 2022; 43:274-279. [PMID: 34558339 DOI: 10.1177/10711007211039526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Level of Evidence: Level V.
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Affiliation(s)
- Felipe Chaparro
- Department of Orthopedic Surgery, Foot and Ankle Center, Clínica Universidad de los Andes, Las Condes, Santiago, Chile
| | - Raul Espinoza
- Department of Orthopedic Surgery, Foot and Ankle Center, Clínica Universidad de los Andes, Las Condes, Santiago, Chile
| | - Manuel J Pellegrini
- Department of Orthopedic Surgery, Foot and Ankle Center, Clínica Universidad de los Andes, Las Condes, Santiago, Chile
| | - Giovanni Carcuro
- Department of Orthopedic Surgery, Foot and Ankle Center, Clínica Universidad de los Andes, Las Condes, Santiago, Chile
| | - Cristian Ortiz
- Department of Orthopedic Surgery, Foot and Ankle Center, Clínica Universidad de los Andes, Las Condes, Santiago, Chile
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Zhang N, Xu H, Huang Z, Wang Y, Li Z, Xu W, Hu Y. Plantar approach for treatment of brachymetatarsia: A novel approach with an aesthetic consideration. J Plast Reconstr Aesthet Surg 2021; 75:1668-1673. [PMID: 34975001 DOI: 10.1016/j.bjps.2021.11.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/04/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022]
Abstract
In the past, open osteotomy was always performed through a dorsal approach in the surgical treatment of brachymetatarsia, which created scar formation on the dorsal skin, subsequently resulting in dissatisfaction with cosmetic results. In this study, we provided a plantar approach to avoid forming scars on the dorsal side. A retrospective review was conducted in nine patients (13 feet) with brachymetatarsia treated with an open osteotomy and gradual bone lengthening through a plantar approach. Visual analogue scale (VAS) was used to evaluate the satisfaction of foot appearance, and we designed a questionnaire called appearance index (AI) to assess the influence of foot appearance on quality of life after surgery. The complications were also recorded during the follow-up. The patients were followed up for 34.8 ± 23.7 months. All cases were healed with a time of 64.4 ± 7.1 days and a healing index of 44.1 ± 7.8 d/cm. Satisfaction VAS for foot appearance improved from a preoperative score of 1.7 ± 1.3 points to a postoperative score of 9.3 ± 0.5 points. The AI improved from a preoperative score of 9.2 ± 0.8 points to a postoperative score of 0.6 ± 0.7 points. Complications were observed in three feet (23.1%), but none was related to the plantar approach. In conclusion, the plantar approach for metatarsal osteotomy and pins fixation was a safe and efficient technique with a satisfactory cosmetic result for the patients. No complications related to the novel approach, such as neurovascular injury, were reported.
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Affiliation(s)
- Ning Zhang
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan 250033, PR China
| | - Hua Xu
- Linyi Cancer Hospital, Linyi, PR China
| | - Zheng Huang
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan 250033, PR China
| | - Yang Wang
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan 250033, PR China
| | - Zhengxun Li
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan 250033, PR China
| | - Wenpeng Xu
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan 250033, PR China
| | - Yong Hu
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan 250033, PR China.
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Matsubara S, Onodera T, Iwasaki K, Hishimura R, Matsuoka M, Kondo E, Iwasaki N. Hallux Valgus With Second Brachymetatarsia Discovered Accidentally: A Case Report. J Foot Ankle Surg 2021; 60:1060-1062. [PMID: 33836969 DOI: 10.1053/j.jfas.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 02/03/2023]
Abstract
Hallux valgus deformity is one of the most common foot and ankle diseases, while brachymetatarsia is a rare foot anomaly with pathological shortening of a metatarsal bone. We present a case of hallux valgus deformity possibly due to second brachymetatarsia. As the hallux valgus was associated with dorsal dislocation of the second toe that made it difficult to evaluate the length of the second toe, the patient was unaware of the second metatarsal shortening until the lengths of the toes compared by manual reposition of the second MTP joint. In this case, proximal osteotomy of the first metatarsal on the hallux valgus and single-stage bone lengthening of the second metatarsal with iliac bone grafting on the second brachymetatarsia were performed. One year after the operation, the callosity of the third toe resolved and the clinical scores were improved. In the case of a hallux valgus deformity with second dorsal dislocation of the toes, surgeons should consider that there are rare cases with second metatarsal shortening. When hallux valgus associated with second brachymetatarsia is diagnosed, second metatarsal lengthening should be considered in addition to hallux valgus surgery.
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Affiliation(s)
- Shinji Matsubara
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tomohiro Onodera
- Senior Lecturer, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Koji Iwasaki
- Orthopaedic Surgeon, Department of Functional Reconstruction for the Knee Joint, Sapporo, Japan
| | - Ryosuke Hishimura
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masatake Matsuoka
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eiji Kondo
- Professor, Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Professor, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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11
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Fusini F, Alessandro M, Rava A, Kristijan Z, Felli L, Colò G. Aetiology, diagnosis, and treatment of brachymetatarsia: a narrative review. Musculoskelet Surg 2021; 106:99-109. [PMID: 34268706 DOI: 10.1007/s12306-021-00720-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Abstract
Brachymetatarsia (BM), or hypoplastic metatarsal, is an abnormal shortening of one or more metatarsal bones with a female-to-male ratio of 10.53:1. Different causes are described in the literature, such as congenital, acquired, or iatrogenic, associated with different conditions and syndromes. Its presence may develop deformity and pain; however, often feet are pain free and the major worries of patients are cosmetics. Non-operative treatments aim to improve the comfort of metatarsal heads and the possible dorsal conflict through comfortable shoes or the use of specific orthotics. The surgical treatment is anything but straightforward, with "one-stage" or "two stage" techniques, the latter better called "by gradual distraction". One-stage procedures are more rapid techniques but have limited ability to restore the desired length due to neurovascular compromise caused by acute lengthening. Insufficient correction is also possible. On the contrary, by gradual distraction procedures allow gradual distraction lengthening of more than 1.5 cm, but require the use of an external fixator, with a higher risk of complications in more than about 50% of surgeries. The adjacent metatarsal shortening should be considered in combination with other techniques, to diminish the excessive lengthening. In each case, surgeries should be always decided on each patient's concerns, deformities, and clinical needs.
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Affiliation(s)
- F Fusini
- Department of Orthopaedics and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Via S. Rocchetto, 99, 12084, Mondovì, CN, Italy
| | - M Alessandro
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Via Zuretti 29, 10121, Turin, Italy
| | - A Rava
- Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Via Zuretti 29, 10121, Turin, Italy
| | - Z Kristijan
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy
| | - L Felli
- Orthopaedic Clinic, Department of Surgical Sciences (DISC), University of Genoa, Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - G Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Via Venezia 16, 16121, Alessandria, Italy.
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12
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Neretin AS, Menshchikova TI. Value of ultrasonography and radiography for the study of bone regeneration in lengthening of the fourth ray in brachymetatarsia. Foot Ankle Surg 2021; 27:432-438. [PMID: 32561159 DOI: 10.1016/j.fas.2020.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Distraction osteogenesis is frequently used for brachymetatarsia. METHODS Brachymetatarsia of the fourth ray was treated with the Ilizarov method in 10 females. Distraction rate was 1.00-0.75mm a day. Radiography and ultrasonography were used to study the regeneration course throughout the distraction and fixation phases. RESULTS Mean lengthening achieved was 2.28cm in the average distraction period of 30.2 days and average fixation phase of 50.2 days. Ultrasonography detected the regeneration signs and zonal structure of the regenerate earlier than radiography. It confirmed slow regeneration in two patients and their distraction rate was corrected. One patient had premature consolidation on distraction day 10 and needed re-osteotomy. CONCLUSIONS Combination of radiography and ultrasonography to study bone regeneration in brachymetatarsisa provides a better monitoring of distraction callus progression. Ultrasonography is of great value to detect regeneration problems during early stages of lengthening.
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Affiliation(s)
- A S Neretin
- National Ilizarov Medical Research Centre for Traumatology and Orthopeadics of the Ministry of Health of Russia, orthopaedic department 6, Russia.
| | - T I Menshchikova
- Laboratory of limb length and deformity correction, National Ilizarov Medical Research Centre for Traumatology and Orthopeadics of the Ministry of Health of Russia, Russia
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13
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Ray J, Andrews NA, Dib A, Harrelson WM, Khurana A, Singh MS, Shah A. Management of acute lesser toe pain. Postgrad Med 2021; 133:320-329. [PMID: 33406375 DOI: 10.1080/00325481.2021.1873581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients with foot pain commonly present to their primary care physicians for their initial management and treatment. These patients and their respective foot or lesser toe pain can present the physician with a complex problem with a long differential list. Depending on the timing of the pain and underlying pathology, these differentials can be divided into acute and acute exacerbation of chronic conditions. This review categorizes the history, physical exam, radiological findings, conservative treatment, and surgical management for each major cause of lesser toe pain, whether acute or chronic. The acute conditions surrounding lesser toe pain in the adult population discussed are toe fractures, toe dislocations, and metatarsal head and neck fractures. The chronic pathologies surrounding lesser toe pain in the adult population evaluated in this review include metatarsalgia, Morton's neuroma, Freiberg infraction, brachymetatarsia, bunionettes, and lesser toe disorders.
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Affiliation(s)
- Jessyca Ray
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicholas A Andrews
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Aseel Dib
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Whitt M Harrelson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ankit Khurana
- Department of Orthopaedic Surgery, Dr. BSA Medical College, Delhi, India
| | - Maninder Shah Singh
- Department of Orthopaedic Surgery, Indian Spinal Injuries Centre, Delhi, India
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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14
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Ekinci Y, Gürbüz K, Arık M, Batın S. Is the One Ray Normal or Are the Rest Shorter?: Brachymetapody-A Case Report. J Am Podiatr Med Assoc 2020; 110:449528. [PMID: 33301583 DOI: 10.7547/20-023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this case report, we present the case of a 20-year-old male patient who suffered from pain in walking clinically, and in whom an extremely rare type of brachymetatarsia was diagnosed. Although distorted body image is the main reason for consulting a specialist, the patient presented because he was unable to find a proper shoe. The patient had no familial history of brachydactyly, trauma, or a genetic disorder. In this extremely rare case, the decision was made to perform shortening of the normal foot ray with a double osteotomy to the metatarsal and proximal phalanx. At the end of the follow-up period, the patient was walking pain-free and had no limitation in shoe choice.
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15
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Fuiano M, Mosca M, Caravelli S, Di Liddo M, Grassi A, Majumdar A, Massimi S, Catanese G, Zaffagnini S. Callus distraction with external fixator for the treatment of congenital brachymetatarsia of the fourth ray. Foot Ankle Surg 2020; 26:693-698. [PMID: 31540836 DOI: 10.1016/j.fas.2019.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 07/07/2019] [Accepted: 08/26/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Brachymetatarsia is a rare abnormality of the foot which occurs most frequently in the first and fourth metatarsals. The aim of this study was to evaluate the efficacy of gradual metatarsal lengthening by external fixator for treatment of brachymetatarsia of the fourth ray. The hypothesis was that with external fixation it would be possible to achieve the desired length of the metatarsal with a low rate of complications. Secondarily, in cases requiring a greater amount of correction, it was hypothesized that an opportune rate of bone consolidation would be achievable using a traditional oscillating saw without predrilling or use of a cold osteotome. METHODS Between 2013 and 2016, 12 eligible patients and 13 feet underwent gradual metatarsal lengthening by an external fixator (MiniRail System M103, Orthofix) due to brachymetatarsia of the fourth ray. Mean age at surgery was 24.5±5.3 years (range 19-36), with mean follow-up of 22.3±8.3 months. Clinical evaluation was performed with the AOFAS lesser metatarsophalangeal-interphalangeal (MTP-IP) score. Radiographic assessment was performed on follow-up using non-weightbearing dorsoplantar foot radiographs. RESULTS The mean AOFAS lesser MTP-IP score improved from a preoperative score of 76.6±7.1 points (range 62-85 points) to a postoperative score of 90.3±3.0 points (range 86-95 points). The average amount of lengthening was 16.8±3.9mm (range 8-22mm). Mean shortening, final lengthening, Healing Index, period of treatment, and complications are also reported. The operative technique is described. CONCLUSIONS Gradual metatarsal lengthening with external fixator is an effective treatment for brachymetatarsia and can restore forefoot anatomy with good clinical outcomes, a low rate of morbidity and complications in selected cases. Particular attention should be given when treating patients with shortening >20mm.
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Affiliation(s)
- Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Michele Di Liddo
- Chirurgia Protesica di Anca e Ginocchio, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Aditi Majumdar
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC10 5600, 1 University of New Mexico, Albuquerque, NM 87131-0001, United States
| | - Simone Massimi
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Catanese
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinic of Orthopaedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
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16
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Forefoot malformations, deformities and other congenital defects in children. Orthop Traumatol Surg Res 2020; 106:S115-S123. [PMID: 31648997 DOI: 10.1016/j.otsr.2019.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 02/02/2023]
Abstract
Congenital pathologies of the forefoot encompass two broad entities with vastly different treatments and prognosis: malformations, which occur during the embryonic period and cause anatomical defects, and deformations, which occur during the fetal period on a foot that is configured normally. These deformities are more easily cured when they occur later during the fetal period. When the anomaly is bilateral, a genetic origin must be considered. There are two main entities under the term "deformity": metatarsus adductus and skewfoot (aka "Z"-foot or serpentine foot). Within malformations are brachydactyly (transverse defects), longitudinal defects, syndactyly, polydactyly, clinodactyly and macrodactyly. Among other forefoot abnormalities are hallux valgus, which rarely presents in congenital form, and for which conservative treatment is sometimes sufficient. Also in this group are sequelae of amniotic band constriction, forefoot anomalies secondary to the treatment of congenital pathologies (talipes equinovarus and congenital vertical talus) and nail-related pathologies (ingrown toe nail and incorrect nail position).
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17
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Abstract
Brachymetatarsia is a rare deformity with controversial clinical presentation. Multiple acute and gradual lengthening surgical techniques have been described for correction of this type of foot deformity. All techniques try to create a better appearance, facilitate shoeing, or solve possible transfer metatarsalgia. Either acute lengthening (1-stage procedure) or gradual lengthening (2 stages) is selected based on the patient's deformities, concerns, and clinical needs.
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18
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Özdemir M, Kavak RP, Akdağ T. A rare case of isolated congenital unilateral brachymetatarsia presenting in a young adult male. Radiol Case Rep 2019; 14:1252-1254. [PMID: 31462949 PMCID: PMC6706637 DOI: 10.1016/j.radcr.2019.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 11/09/2022] Open
Abstract
Congenital brachymetatarsia is a rare skeletal anomaly which is characterized by the abnormal length reduction of one or more metatarsal bones. It occurs as the result of the early closure of the growth plate. While the majority of the reported cases are idiopathic, it can also be seen in association with various genetic conditions or syndromes. Brachymetatarsia most commonly involves the fourth metatarsal followed by the first metatarsal. This rare disorder is mostly bilateral and reported almost exclusively in females. Herein, we present a rare case of congenital unilateral brachymetatarsia which was incidentally detected in a young adult male.
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Affiliation(s)
- Meltem Özdemir
- Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Radyoloji Kliniği, Ziraat mah. Şehit Ömer Halisdemir cad. No:20, Altındağ, Ankara, Turkey
| | - Rasime Pelin Kavak
- Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Radyoloji Kliniği, Ziraat mah. Şehit Ömer Halisdemir cad. No:20, Altındağ, Ankara, Turkey
| | - Tuba Akdağ
- Department of Radiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Radyoloji Kliniği, Ziraat mah. Şehit Ömer Halisdemir cad. No:20, Altındağ, Ankara, Turkey
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19
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Waizy H, Polzer H, Schikora N, Forth A, Becker F, Stukenborg-Colsman C, Yao D. One-Stage Metatarsal Interposition Lengthening With an Autologous Fibula Graft for Treatment of Brachymetatarsia. Foot Ankle Spec 2019; 12:330-335. [PMID: 30280593 DOI: 10.1177/1938640018803731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Brachymetatarsia is defined as the pathological shortening of a metatarsal bone, which can cause cosmetic problems and pain in the forefoot. The main surgical treatment options are: extension osteotomy, interposition of a bone graft, and callus distraction. Usually, a bone graft from the iliac crest is used for the interposition osteotomy. The operative technique of graft extraction from the fibula has not been described in the literature yet. Methods: Eight feet with brachymetatarsia in 5 patients were evaluated retrospectively. The minimum follow-up period was 2 years. Via a dorsal V/Y skin incision, a central osteotomy on the metatarsal bone was done. A graft was obtained from the anterior fibula. The graft was inserted and fixed by a locking plate. Additional soft tissue procedures were done. Results: We had bony consolidation in all cases. The mean extension was 9.01 mm (5.49 to 12.54 mm). This corresponded to a mean 20.3% extension of the entire metatarsal. High patient satisfaction as well as high satisfaction regarding the cosmetic results were achieved. There were no postoperative complications. The range of motion of the metatarsal-phalangeal joint IV was 20% less preoperative in terms of plantar flexion. Standing up on tiptoes was possible in all patients postoperatively. One patient reported mild symptoms after sports activities. Conclusions: Because of its anatomy the graft adapts to the metatarsal IV bone. As our study showed, harvesting from the distal fibula causes no functional restriction. In terms of wound and bone healing as well as pain symptoms, this method should be considered as an alternative to the standard iliac graft.
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Affiliation(s)
- Hazibullah Waizy
- Hessing Stiftung, Augsburg, Germany.,Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Hans Polzer
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | | | | | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | | | - Daiwei Yao
- Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany
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20
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Abstract
Brachymetatarsia is a malformation characterized by an abnormal reduction in the length of 1 or more metatarsal bones. It occurs because of early closure of the growth plate of the affected metatarsal. Generally, it is caused by a congenital disorder and it usually occurs bilaterally. With a greater prevalence in females, it most often affects the fourth metatarsal, followed by the first metatarsal. Surgical treatments proposed include using external mini-fixators or bone grafts in a single step to lengthen the metatarsal. In this review, 62 scientific articles about brachymetatarsia were analyzed with key demographic and epidemiological aspects of this pathology. The prevalence of bilateral brachymetatarsia was 47%, and the female to male ratio was 10.53:1. Both these findings appear to contradict the usual data reported for brachymetatarsia. A better understanding of this disorder will enable an appropriate therapeutic approach according to the psychological and social profile of affected individuals.
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21
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Coriaty N, Pettibone K, Todd N, Rush S, Carter R, Zdenek C. Titanium Scaffolding: An Innovative Modality for Salvage of Failed First Ray Procedures. J Foot Ankle Surg 2018; 57:593-599. [PMID: 29331289 DOI: 10.1053/j.jfas.2017.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Indexed: 02/03/2023]
Abstract
Shortening of the first ray is a potential complication associated with first metatarsal procedures. Correction of this deformity conventionally has required the use of a tricortical bone graft to lengthen the bone. Graft complications, including donor site morbidity, poor graft stability, and graft resorption, have revealed a need for an alternative procedure. The present report shows that titanium cage scaffolding has lower extremity applications beyond its previous uses in the ankle and spine. Two patients underwent surgical correction for failed first ray procedures using a titanium cage apparatus with a calcaneal autograft and other biologic agents. The scaffolds were appropriately sized to fill the defect. Patients remained non-weightbearing until radiographic evidence of healing appeared. Success was determined by diminished pain, a return to activity, ambulation, and patient satisfaction. Patients exhibited faster-than-anticipated healing, including a return to protected weightbearing activities and increased stability within 6 weeks. Titanium cage implants provide long-term stability and resistance to stress and strain in the forefoot. The implant we have described, newly applied to the first ray, is analogous to a system used in salvage of failed ankle replacements. In addition to reducing reliance on the iliac crest bone graft, the titanium cage apparatus is advantageous because it is customized to fill a defect using computed tomography scanning, thereby reducing graft failure secondary to an improper shape. These cases demonstrate the potential beneficial applications for titanium cages in failed first ray reconstruction.
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Affiliation(s)
- Natalie Coriaty
- Fourth-year Student, California School of Podiatric Medicine, Oakland, CA
| | | | - Nicholas Todd
- Attending Physician, Chief of Surgical Services, Camino Division, Palo Alto Medical Foundation, Mountain View, CA.
| | - Shannon Rush
- Attending Physician, Chief of Foot and Ankle Surgery, Palo Alto Medical Foundation, Mountain View, CA
| | - Ryan Carter
- Fellow, Palo Alto Medical Foundation, Mountain View, CA
| | - Colin Zdenek
- Fellow, Palo Alto Medical Foundation, Mountain View, CA
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22
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Peña-Martínez VM, Palacios-Barajas D, Blanco-Rivera JC, Arnaud-Franco Á, Elizondo-Rodríguez JA, Acosta-Olivo C, Vílchez-Cavazos F, Morales-Avalos R. Results of External Fixation and Metatarsophalangeal Joint Fixation With K-Wire in Brachymetatarsia. Foot Ankle Int 2018; 39:942-948. [PMID: 29641262 DOI: 10.1177/1071100718770388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Brachymetatarsia is a rare foot deformity caused by the premature closure of the metatarsal physis. It may result in functional as well as cosmetic alterations, which may require operative management. METHODS A prospective study examining outcomes of 48 cases of brachymetatarsia with gradual bone lengthening at a rate of 1 mm/d using an external fixator and metatarsophalangeal joint fixation was performed. The difference between the length before treatment and after external fixator removal was measured. The patients were assessed at 2, 4, 6, and 8 weeks postoperatively; at the end of the period of distraction; and 1 year after surgery. The total number of patients was 26, and surgery was performed in 48 metatarsals. The mean age was 17.0 ± 4.1 (range, 11-24) years, and all were female. RESULTS The fourth metatarsal was the most frequently affected, representing 98% of the cases; the third metatarsal represented the other 2%. The average length gained was 18.6 ± 6.7 mm, and the average length gained as a proportion of the original metatarsal length was 38.2% ± 3.1% (range, 13%-24%). The mean healing time was 71.0 (range, 64-104) days, and the mean healing index (healing time divided by centimeters of length gained [d/cm]) was 38.4 (range, 38.2-50.1) d/cm. CONCLUSION Gradual bone lengthening at a rate of 1 mm/d using an external fixator and intramedullary nailing was a safe and efficient method, representing a minimally invasive procedure with a low incidence of complications and satisfactory results for the patient. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Víctor Manuel Peña-Martínez
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Dionisio Palacios-Barajas
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Juan Carlos Blanco-Rivera
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Ángel Arnaud-Franco
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Jorge Alberto Elizondo-Rodríguez
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Carlos Acosta-Olivo
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Félix Vílchez-Cavazos
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
| | - Rodolfo Morales-Avalos
- 1 Module of Politrauma, Reconstruction and External Fixation, Department of Orthopaedics and Traumatology, University Hospital "Dr. José Eleuterio González," Universidad Autónoma de Nuevo Leon, Monterrey, Nuevo León, México
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Abstract
Background Brachymetatarsia is usually treated by lengthening the metatarsals, but excessive lengthening can be associated with complications. Our technique combines 1-stage step-cut lengthening of the first metatarsal with shortening and/or lengthening of the neighboring metatarsals and/or phalanges. Methods Twenty-four feet (15 patients) were treated for first-ray brachymetatarsia. Widely available commercial image-editing software was used to make a preoperative plan for each patient, with emphasis on the creation of a cosmetically satisfying toe-length arc with minimum shortening and lengthening of the affected metatarsals and proximal phalanges. Length gain and percentage increase were also recorded postoperatively. The American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scoring system was used for clinical evaluation. Results In all 24 feet, smooth parabolas were created at the level of the metatarsal heads and at the toe tips. All patients showed osseous union, and no complications were noted. However, most patients showed mildly restricted range of motion of the first metatarsophalangeal joint. The mean AOFAS score of the hallux significantly improved from 88.3 preoperatively to 98.1 at the latest follow-up (p < 0.001). Conclusions One-stage step-cut lengthening of the first metatarsal combined with shortening and/or lengthening of the adjacent metatarsal and phalangeal bones provides excellent cosmetic and functional results. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hui Taek Kim
- Department of Orthopaedic Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sung Min Hong
- Department of Orthopaedic Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - In Hee Kim
- Department of Orthopaedic Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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24
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Distraction Osteogenesis for Brachymetatarsia by Using Internal Device. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1381. [PMID: 28831337 PMCID: PMC5548560 DOI: 10.1097/gox.0000000000001381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/25/2017] [Indexed: 11/26/2022]
Abstract
Congenital brachymetatarsia most commonly involves the fourth ray and may be combined with metacarpal shortening. Now, many reports demonstrated the usefulness of distraction osteogenesis for lengthening of the metatarsals by using an external distraction device. In this article, we treated shortening fourth metatarsal by bone lengthening using the internal distraction device. This technique has some advantages over the method of external distraction.
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Treatment of Complications after Distraction Osteogenesis for Brachymetatarsia of the Fourth Metatarsal. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e817. [PMID: 27536496 PMCID: PMC4977145 DOI: 10.1097/gox.0000000000000836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/01/2016] [Indexed: 11/27/2022]
Abstract
Congenital brachymetatarsia most commonly involves the fourth ray and may be combined with metacarpal shortening. Numerous reports have demonstrated the usefulness of gradual lengthening of the metatarsals. However, very few studies have investigated methods of recovering the lost regenerative bone. The patient was a 16-year-old girl with bilateral brachymetatarsia of the fourth metatarsal. After a long consolidation period after gradual lengthening of the fourth metatarsal by 20 mm, the patient had an hourglass-shaped regenerated bone. Therefore, we grafted a bioabsorbable hydroxyapatite and collagen composite. Six months after the surgery, well-regenerated bone could be recognized on radiographic evaluation and was resistant to refracture. Callus distraction is a method that aims to avoid donor site morbidity. The strength of artificial bone is often a problem. Bioabsorbable hydroxyapatite and collagen composite compensates for the lack of regenerated bone and distraction gap and prevents refracture, thus preventing complications after metatarsal distraction.
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