80: Metatarsal Lengthening

Fig. 1

Pre-operative image of the right foot showing a shortened 4th toe with overriding of the 4th toe on the adjacent 5th toe

Fig. 2

Pre-operative radiograph of the right foot that shows a shortened right 4th metatarsal and a break in the normal metatarsal-phalangeal cascade

3 Preoperative Problem List

Bilateral short 4th metatarsals

Intermittent transfer metatarsalgia and footwear problems

Unacceptable cosmetic appearance

4 Treatment Strategy

Acute lengthening has been described for deformities that are under 1 cm. The skin, nerves, and vessels in this area tend not to restrict acute lengthening as the surrounding toes are of normal length, maintaining adequate tension of the soft tissues.

Baek and Chung (1998) were able to acutely lengthen different metatarsals by 11–65 % of their original length without difficulty.

Deformities of >1 cm as in this case should be lengthened gradually.

Deformity correction should be performed when the patient is skeletally mature as the metatarsal is more robust to accept hardware and the risk of damage to the physis is negated.

5 Basic Principles

The goal of treatment is to improve the biomechanics of the foot by restoring the metatarsal-phalangeal cascade. This helps prevent abnormal loading of the surrounding metatarsal heads.

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