As Brachymetatarsie a shortening of the metatarsal is called, which is already innate. It is a form of brachyphalangia.
What is a brachymetatarsia?
According to whicheverhealth, brachymetatarsia is a deformity of the foot. The growth in length of the metatarsal bone is stopped at an early stage. In most cases, the 1st and 4th metatarsal bones are affected by this process.
As a result of this deformity, the fourth toe does not shift towards the tip of the foot, as is usual in the growth process. This makes the affected toe appear smaller than its neighboring toes. However, their size is usually completely normal. In Germany alone, around 25,000 to 27,000 German citizens suffer from brachymetatarsia.
For many of those affected, this not only creates aesthetic problems, but also emotional and psychological effects. The rare abnormality is 26 times more common in women than in males. Brachymetatarsia is a form of brachyphalangia, although there is no shortening of a finger.
Doctors classify the deformity as type E brachydactyly. A shortening of the metacarpal bone, on the other hand, is called brachymetacarpy. The first description of brachymetatarsia was in 1951 by the British physician Julia Bell. For this purpose she evaluated fifteen previous case reports.
Causes
The exact causes of the brachymetatarsia have not yet been determined. As a rule, those affected have suffered from the deformity since birth. Numerous medical professionals suspect an autosomal dominant inheritance.
Occasionally, however, brachymetatarsia is also part of an existing syndrome and associated with other symptoms. This is especially true for generalized skeletal dysplasias, basal cell nevus syndrome, Albright osteodystrophy and Turner syndrome.
In the context of Albright osteodystrophy, brachymetatarsia often marks the first sign of pseudohypoparathyroidism type 1A or 1B and has been present since birth. Other skeletal dysplasias, on the other hand, only show up at the age of two to four years or even in adults.
Symptoms, ailments & signs
In most cases, the brachymetatarsia is noticeable on the first metatarsal bone. The big toe is much shorter and there is a disruption of the normal foot roll over the ball of the big toe. This in turn results in increased stress on the second and third toe.
Patients can suffer from forefoot pain because the transverse arch is affected by disorders. In around 40 percent of all people, however, the first metatarsal bone is generally slightly smaller than the second bone. However, a brachymetatarsia is only mentioned when there is a clear shortening.
In principle, all other metatarsals can also be affected by the brachymetatarsia. This primarily includes the fourth metatarsal. The toe, which is actually not shortened, is placed in the upper direction on the neighboring toe, which can lead to pressure points. However, this is usually not an orthopedic, but an aesthetic problem.
The mental or psychological problems that are often caused by brachymetatarsia should also be considered. The foot deformity often has a negative effect on the self-confidence of those affected and they feel stigmatized.
Since many patients no longer perceive themselves as attractive, this sometimes leads to sexual problems. In addition, many of those affected do not dare to show their partners their feet. Furthermore, public life is restricted, which has a negative effect on going to the beach or swimming, for example.
diagnosis
The diagnosis of brachymetatarsia is easy. The clear foot deformities clearly indicate the anomaly. Only rarely do those affected have the courage to see a doctor.
However, they are often told that there would be no treatment options for them, so they should come to terms with their problem. Sometimes even going to a psychologist is recommended. In the meantime, however, there are modern and promising surgical methods with which the brachymetatarsia can be corrected.
Brachymetatarsia cannot be corrected on its own. Surgical intervention is required to achieve this. If this correction is successful, the affected person regains a normal quality of life.
Complications
In many cases, brachymetatarsia is a purely aesthetic problem. However, if the deformities are very pronounced, severe pain can also occur, which mainly occurs in the forefoot. As a result, the person affected is relatively restricted in their movement and in everyday life.
Sports activities cannot always be carried out either. Due to the deformity, many patients lose self-esteem and they do not find themselves attractive. Most of all, this leads to sexual problems and depression. The shame of one’s own feet in brachymetatarsia also avoids public experiences on which feet are shown. Above all, this includes visits to the beach or swimming pool.
Treatment of brachymetatarsia is possible without complications. However, this requires surgical interventions to lengthen the bone on the foot. The interventions can either reduce the stress on the foot or be purely cosmetic in nature. Since the body is still growing at a young age, the operations are only carried out after the age of 16. There are no other complaints or problems after the operation.
When should you go to the doctor?
Since brachymetatarsia is a congenital disease, there is no need to see a doctor to diagnose this disease. As a rule, a visit to the doctor should take place if the illness leads to restrictions in everyday life or in the patient’s movement. Especially in children, this can disrupt or delay development so that treatment by a doctor can prevent possible complications in adulthood.
An examination and treatment by a doctor should also take place if the brachymetatarsia leads to psychological complaints and restrictions. Children and adolescents in particular can suffer from severe psychological complaints or depression. If these symptoms arise, cosmetic and psychological treatment must take place, and the diagnosis can be made by a general practitioner. The treatment of this complaint is then carried out by a respective specialist or by a surgical procedure in a hospital.
Treatment & Therapy
From a medical point of view, the surgical treatment of a brachymetatarsia on the first metatarsal bone usually serves to counteract overloading of the smaller neighboring toes. Surgery on the second to fifth metatarsal, on the other hand, is carried out for cosmetic reasons. However, it is important to wait for the growth process to end before performing surgery. The operation must therefore not take place before the age of 16.
One-stage lengthening of the metatarsal is one of the proven surgical procedures for treating brachymetatarsia. A transplant made from the body’s own or synthetic bones is implanted. Another method is callus distraction, in which either an internal or external fixator is used.
With this procedure, the metatarsal bone that is too short can be lengthened step by step over a period of several months. The fixator is only removed when the bone has sufficient stability. If the shortening is slight, a corrective osteotomy is also possible. The surgeon cuts the metatarsal on its long side and distracts it. Then he fixes the bone with a small osteosynthesis.
Outlook & forecast
There is no prospect of a cure or alleviation of the symptoms without medical treatment. The bone structure is shortened for genetic reasons and remains in its modified form until the end of life without an operation. The administration of medication or the implementation of special training are also unsuccessful according to the current state of science, since human genetics cannot and must not be influenced.
On the other hand, an operation on the foot with the purpose of changing the bone is very promising. This is done after the patient’s growth process has been completed. Cosmetic changes can be made during growth, but they are neither recommended nor result in a permanent solution.
At the end of physical growth, the bones can be corrected in a surgical procedure. In an extension of the bones, the affected toe is adjusted to the desired size. If necessary, physiotherapy is recommended in order to learn the changed gait without complications. In most cases, the patients are subsequently symptom-free and healed.
In individual cases, adversities can arise that result in poor posture of the body or unsteady gait. These can usually be remedied by wearing orthopedic shoes or having another operation.
Prevention
Unfortunately, it is not possible to prevent brachymetatarsia. The deformity of the foot has existed since birth.
You can do that yourself
Those affected have no way of treating the cause of the shortening of the metatarsal bone. Very often, however, the deformation is not associated with physical, but primarily with mental suffering.
Those affected often feel stigmatized because of their suffering and therefore avoid all situations in which their bare feet are visible to third parties. For this reason, water sports or beach visits are avoided and never go barefoot. In the near social field, too, there are often inhibitions that, in extreme cases, even put a strain on the civil partnership.
Adults can have surgical toe lengthening performed by an expert who specializes in aesthetic foot surgery. If the operation is exclusively of a cosmetic nature, those affected have to bear the costs themselves. However, this is not the case if the affected person is severely suffering from the shortened toe. Anyone who is considering an operation should in any case find out about the possibilities of reimbursement from their health insurance company in advance.
Surgery cannot be performed on children and adolescents who are still growing. However, especially during puberty, visual anomalies become a major problem for adolescents. Parents should take their children’s fears seriously and not trivialize the problem. At the latest when a young person begins to isolate himself socially, the help of a psychologist should be sought.
