Brachymetatarsia. A new surgical approach

Problems, obstacles, and complications of metatarsal lengthening for the treatment of brachymetatarsia

Metatarsal lengthening by distraction osteogenesis is a challenging procedure that is associated with various adverse results. This article presents and classifies adverse results arising from metatarsal lengthening. Our premise of classification is that not all adverse results that occur secondary to distraction osteogenesis of the metatarsal are true complications that affect the final outcome, but rather are problems and obstacles that present hurdles to completion of treatment. Our classification differentiates among problems, obstacles, and complications during metatarsal lengthening with external fixation. The cause of each adverse result is also discussed and clinical and surgical pearls to avoid these problems, obstacles, and complications are presented.

Percutaneous distraction osteogenesis for treatment of brachymetatarsia

Brachymetatarsia is not an unusual deformity and is often associated with functional and cosmetic issues that warrant surgical reconstruction. Lengthening of the affected metatarsal can be undertaken on an acute basis in a single operative procedure that involves the use of a bone graft or by means of gradual callus distraction. Because of the risk of metatarsophalangeal joint malalignment, it is important for the surgeon to take steps to stabilize the joint during the lengthening process. In this report, a percutaneous method of callus distraction for repair of brachymetatarsia and maintenance of metatarsophalangeal joint alignment is presented.

Brachymetatarsia

Brachymetatarsia is a rare clinical entity that presents a complicated case to the treating surgeon. One-stage lengthening procedures with a variety of biologic and synthetic implants are preferred for metatarsals that only need to be lengthened up to 15 mm, whereas gradual lengthening allows for greater length gain and concomitant lengthening of the soft tissues. Adjacent metatarsal shortening may be used in conjunction with lengthening procedures to restore the parabolic arc of the metatarsal heads. Management should be tailored to the patient's individual deformity and expectations. Individualization of surgical techniques and patient selection criteria can result in a cosmetic, functional result that is satisfactory to the clinician and the patient.

Callus distraction in reconstructive foot surgery

Though by no means a new concept, the science of callus distraction has stimulated significant interest among surgeons over the past several years. As our knowledge and understanding of the principles of this technique have evolved, the clinical indications have been expanded. In this manuscript, we will illustrate several examples of these broadened indications. An innovative alternative to the Evans opening wedge calcaneal osteotomy, which usually requires bone graft or bone graft substitutes, is presented.