Percutaneous Distraction Osteogenesis for Treatment of Brachymetatarsia

  • Bradley M. Lamm
  • Dror Paley
  • John E. Herzenberg


A short metatarsal can be acquired or congenital in origin.1 A congenitally short metatarsal or brachymetatarsia presents unilaterally or bilaterally, typically involving the fourth metatarsal (Figs. 53.1 and 53.2). Congenitally short metatarsals can occur in isolation or in association with systemic syndromes, endocrinopathies, and dysplasias. Syndactyly or polydactyly can occur in combination with congenitally short metatarsals. The cause of brachymeta-tarsia is thought to be premature closure of the metatarsal epiphyseal growth plate (Fig. 53.3). Acquired short metatarsals are caused by trauma, infection, tumor, Freiberg disease, radiation, and surgery. In addition, acquired short metatarsals can be associated with skeletal and systemic abnormalities (sickle cell anemia, multiple epiphyseal dysplasia, mul-tiple hereditary osteochondromas, and juvenile rheumatoid arthritis). Surgically induced (iatrogenic) shortening of metatarsals are caused by transphyseal fixation, osteotomies of the metatarsals, and internal or external fixation producing a growth arrest or synostoses between metatarsals. A failed bunionectomy or overly aggressive first metatarsal cuneiform arthrodesis also can result in an acquired short first metatarsal.1,2


Sickle Cell Anemia External Fixation Juvenile Rheumatoid Arthritis Distraction Osteogenesis Metatarsal Head 



I thank Alvien Lee for expertise and assistance with the photography.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Bradley M. Lamm
    • 1
  • Dror Paley
    • 1
  • John E. Herzenberg
    • 1
  1. 1.Rubin Institute for Advanced OrthopedicsSinai Hospital of BaltimoreBaltimoreUSA

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