Hammertoe Surgery: Toe Lengthening (Brachymetatarsia)

The 26 Review

  • What is Brachymetatarsia? One or more metatarsal bones are abnormally shorter than usual
  • How Bone cuts, bone grafts, and/or specialized devices are utilized.
  • Why To improve weight distribution, alleviate pain, and  appearance of the toes
  • Recommended for Patients who struggle with foot pain and discomfort while walking
  • Length of Treatment 1-2 hours depending on complexity of deformity
  • Downtime 8-12 weeks of downtime
26 Foot and Ankle Hammertoes

Let’s take a closer look…

Brachymetatarsia is a congenital orthopedic condition characterized by the abnormal shortening of one or more metatarsal bones. The metatarsal bones are the long bones in the middle part of the foot, connecting the toes to the midfoot. This condition can affect one or multiple toes and is typically present from birth, because of this, unequal toe lengths can impact the appearance and function of the foot. Individuals with brachymetatarsia can experience discomfort, pain, and difficulty finding well-fitting footwear. Cosmetic concerns are also common with this ailment, leading to self esteem issues and body image challenges. In some cases, brachymetatarsia can affect an individual’s gait and balance due to the altered mechanics of the foot. Treatment options depend on the severity of the case and can range from non-surgical approaches, such as orthotic devices, to surgical interventions, like bone lengthening procedures. The ultimate goal of treating brachymetatarsia is to alleviate pain, improve foot function, restore any cosmetic issues, and enhance the patient’s overall quality of life.

Procedure Details: Pre, During & Post Surgery Expectations

If you or someone you know has painful brachymetatarsia, it is beneficial to schedule a consultation with a qualified podiatrist to discuss the condition, surgical options, and expected outcomes. If surgery is determined to be the best treatment plan, the following will occur: a comprehensive medical evaluation, advanced imaging tests, and an open discussion about the patient’s goals, concerns, and expectations. During this time, pre-operative instructions will be given, which includes fasting before surgery, stopping certain medications, and avoiding tobacco and alcohol. This procedure is an out-patient surgery, meaning it’s important to plan for post-operative recovery, including arranging for someone to assist during the initial healing process. 

Anesthesia will be administered to ensure the patient’s comfort during the procedure. To begin, an incision will be made near the base of the affected toe to access the metatarsal bone. Typically, a series of bone cuts and either bone grafting or the utilization of external fixators and/or internal implants will be used to gradually lengthen the bone(s). Sutures are then used to close the incision, with attention to minimizing scarring and maintaining proper alignment. Surgery duration will vary based on the complexity of the procedure, but patients can expect it to take between 1 to 2 hours per toe. 

During the initial healing phase, patients might experience pain, swelling, and discomfort. Pain management medications will be prescribed by your healthcare provider to aid in managing post-operative pain and discomfort. Elevating the foot is crucial to minimize swelling and assist in the healing process. Around 4 to 6 weeks post procedure, physical therapy and rehabilitation can begin to help individuals regain strength, mobility, and proper gait. Remember that each patient’s experience will vary, so it’s important to follow the guidance of your Podiatrist throughout every phase of the process.

Benefits and Risk Factors

Patients considering toe lengthening surgery should carefully weigh the benefits and potential risks, and they should have an open discussion with their podiatrist to make an informed decision. Like every surgery, there are a multitude of benefits, as well as some risk factors. Toe lengthening surgery can help restore a more balanced and functional foot structure, enhancing walking and weight distribution. The surgery can also alleviate discomfort and pain associated with conditions like brachymetatarsia by creating a more natural alignment of the toes. Additionally, correcting toe length imbalances can improve gait and overall mobility, reducing the risk of developing gait abnormalities. Lastly, toe lengthening surgery can address cosmetic concerns, providing individuals with a more symmetrical and aesthetically pleasing appearance. 

As previously mentioned, there are potential risks related to anesthesia, infection, bleeding, and adverse reactions to the surgical materials. Infections at the surgical site can delay healing and require additional treatment, making it incredibly important to follow the medical professionals post-operative care instructions. Healing can also take longer than expected, leading to prolonged recovery time. In the event of nerve damage, numbness, tingling, or altered sensation can happen in the affected area. In conjunction, internal implants or fixators could cause irritation, discomfort, or the need for additional surgery if serious complications arise. Lastly, despite the surgery’s success, some patients may experience a slightly reduced range of motion in the affected toes. 

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