Brachymetatarsia: What it is and how the surgery works
SmartHallux® Method
Smarthallux explains to you
All you need to know
on brachymetatarsia
What does brachymetatarsia mean?
Brachymetatarsia is a clinical condition in which one or more metatarsals are shorter than normal. This can cause pain, foot deformity, and difficulty walking.
It usually affects the fourth metatarsal, resulting in the fourth toe being shortened and often overlapping the third and fifth toes. It may be associated with other deformities, particularly a shortened first metatarsal, resulting in what is known as Morton's syndrome (different from Morton's neuroma).
This is a condition that isn't present at birth but manifests around 7-9 years of age and is linked to the premature closure of the growth plate of the fourth metatarsal. It can have congenital or, more rarely, traumatic causes.
It has a clear prevalence in females, with a female-to-male ratio of 25:1. Its incidence in the general population is 0,2-0,5% and in 90% of cases it involves the 4th metatarsal, appearing on one side or both feet.
What causes brachymetatarsia?
As for the causes of brachymetatarsia, it has been discovered that it is due to an early closure of the metatarsal growth nuclei. Several studies have found that genetic factors play a significant role in the onset of brachymetatarsia of the foot.
In the presence of these factors, the probability of developing this condition increases significantly, especially if there have been cases of this malformation in the family history.
La brachymetatarsia It is therefore closely linked to genetic factors. Medical research has succeeded in identifying some specific genes which, once mutated, interrupt the normal development of the bones of the foot. The genes in question play a fundamental role in bone growth, but also in the correct alignment of the metatarsal bones during the growth phases.
Transmission of this condition often follows an autosomal dominant pattern. It is sufficient that a single mutated allele to develop brachymetatarsia.
However, there are cases in which it occurs sporadically. This suggests that the environmental factors or new mutations play a key role
Brachymetatarsia is a significant condition that can have both aesthetic and functional repercussions.
Although the diagnosis is easily made by the patient, a specialist visit is essential to discuss and plan the treatment path.
The diagnosis of the brachymetatarsia
To decide the patient's therapeutic path, the doctor uses an x-ray of the weight-bearing foot. This is an examination performed with the patient standing, because the foot works while standing and the pathology manifests itself while standing.
Ultrasound, magnetic resonance imaging (MRI) and computerized tomography (CT) are second-level investigations, useful in certain situations, but which often provide the surgeon with less information than x-rays, as they are performed in a reclining position (lying down).
Treatment of brachymetatarsia
Conservative treatment for brachymetatarsia depends on the patient's symptoms and the extent of the disease. In the early stages, the use of an orthotic can relieve pain, especially if the primary symptom is metatarsalgia.
However, even the insole is not free from complications, particularly related to the thickness of the insole which can worsen the conflict of the dorsal exostosis and the claw toes with the upper of the shoe.
Furthermore, the insole, like the numerous braces on the market, does not have a "corrective" effect, but only improves the support of the foot and its effect disappears when its use is stopped.
Furthermore, the use of insoles or changes in daily activities and footwear have no effect on metatarsal length or toe overlap. Therefore, there is no effective method for correcting brachymetatarsia other than surgery.
brachymetatarsia: Anesthesia
Surgical techniques have undergone significant evolution compared to the past, starting with anesthesia and postoperative pain control. Spinal and general anesthesia have given way to peripheral anesthesia.
Through an injection behind the knee, only the area between the knee and the foot is anesthetized. Sedation is then administered, eliminating the risks of general anesthesia, allowing the patient to feel less anxious and, often, to wake up immediately after the surgery.
The goal of surgery is to re-establish the correct relative length of the metatarsals according to well-defined parameters, restore the length of the toes and recreate a harmonious, functional and aesthetically pleasing foot.
There are various techniques, the most frequently used of which involve the use of a mini-external fixator to gradually lengthen the metatarsal or the use of plates, screws and/or metal wires to achieve immediate correction.
Considering that very often, for aesthetic and functional reasons, more corrections are required in addition to lengthening the metatarsal and to avoid the use of the external fixator, which is often poorly tolerated, I use a "one-step" surgical technique to obtain an immediate and definitive correction.
brachymetatarsia: The surgery
The most commonly used technique is the result of various evolutions of previous techniques. The fourth metatarsal bone is cut to restore its ideal position with the help of synthetic bone (without taking any from the patient or using cadaver bone) and, depending on the specific case, one or more "small holes" to correct other deformities and create a beautiful and functional foot.
In addition to correcting the functionality of the foot, it is also possible to correct its aesthetics, improving the shape and length of the toes and decreasing their diameter in order to obtain a foot with a more pleasant appearance and which fits more easily with the desired shoes, even more tapered and with a high heel.
The operation is generally performed in day surgery. The patient enters the hospital in the morning and returns home the same evening.
Complications and risks of the surgery
The risks and complications associated with brachymetatarsia surgery are very rare, especially with minimally invasive surgery.
These include bleeding, allergic reactions, infections, deep vein thrombosis, embolisms and skin complications, nerve damage with loss of sensation, persistent pain at the scar, delayed union, pseudoarthrosis, and joint stiffness.
SmartHallux®: Innovative Minimally Invasive Technique
The return to activities
The day after surgery, when sensation is fully recovered, the patient can walk with full support of the foot, wearing a specific brace for this type of surgery.
The first check-up is performed approximately 15 days after surgery. During this check-up, the stitches are removed and a second bandage is applied.
A second check-up is performed approximately four weeks after surgery, during which all bandages are removed and the patient can return to weight-bearing without any aids, wearing a pair of comfortable shoes. After four to six weeks, the patient can return to driving. Full recovery generally occurs two to three months after surgery. The patient can return to contact sports after three to four months. Water walking rehabilitation, or hydrokinesitherapy, can help the patient recover more quickly.
Why choose SmartHallux for surgery?
Our doctors, led by Dr. Manzi, have extensive experience in the treatment of brachymetatarsia with a very high percentage of satisfied patients.
The secrets of our success lie in the use of the best surgical and anesthesiological techniques, and the use of cutting-edge, top-quality materials.
Waiting times for brachymetatarsia correction surgery through the National Health Service (NHS) can be very long, varying from region to region and from facility to facility. In some cases, the wait can be several months or even years. SmartHallux offers the possibility of accessing the procedure more quickly, avoiding long waiting lists.
Regarding costs, brachymetatarsia correction surgery can vary depending on the technique used, the complexity of the case, and the healthcare facility where it is performed. Typically, the average cost is around €9-€10.000. At SmartHallux, thanks to the advanced technique used and our collaboration with several clinics, you can obtain a significantly more competitive price.
SmartHallux® Certified Clinics
Our offices
San Camillo Nursing Home - Via Mauro Macchi, 5, 20124 Milan MI
UPMC Salvator Mundi International Hospital V.le delle Mura Gianicolensi, 67, 00152 Rome RM
Ruesch SPA Clinic Viale Maria Cristina di Savoia, 39, 80122 Naples NA
Smarthallux Netherland - Statenplein 21 - 2582 EZ Den Haag
SmartHallux United Kingdom - Cromwell Hospital 164-178 Cromwell Rd, London SW5 0TU, United Kingdom
Smarthallux Madrid - Calle de Hermosilla 95 - 28006 – Madrid Spain
FAQ
There are several options for booking a consultation with Dr. Manzi.
Dr. Manzi visits medical practices that collaborate with SmartHallux located in Rome, Milan and Naples
It is also possible to book a telemedicine visit.