When you count your child’s little piggies, do you notice that the 4th toe is starting to look like it is afraid of the floor? There may be a bigger problem than that piggy not getting any roast beef. (If you are confused look up the “This Little Piggy” nursery rhyme). Usually when a toe is shorter than the rest, most commonly the 4th toe, a condition called brachymetatarsia is present.
Brachymetatarsia is a condition caused by a premature closure of the growth plate in the metatarsal bone of the foot. The metatarsal is the bone within the foot directly behind the affected toe. Arrest of growth plate occurs due to genetic factors, but more commonly trauma. Discontinued growth of the growth plate leads to failure of normal growth of the affected metatarsal. It also leads to the most obvious problem, an elevated and short contracted toe.
The cosmetic appearance of the affected toe can be the most devastating part of this disorder. Patients can feel embarrassed and afraid of ridicule from their peers. These children may avoid activities like swimming or wearing open toed shoes, making fitting in with others difficult. As patients age into their teenage years, the disparity in length of the metatarsals increases. The affected toe then appears very short compared to the other toes, and this disparity can lead to calluses and/or pain on the bottom of the foot or to the top of short toe as it rubs on shoes.
So, what can be done?
Conservative treatment cannot straighten the toe or lengthen metatarsal, but can reduce pain from deformity. Calluses can simply be trimmed, sanded with pumice stone or softened with medicated creams. Custom orthotics can be utilized to reduce pressure to the pads of foot if they have begun to experience increased pressure and pain. Accommodative toe padding or deeper shoes can alleviate painful contracted toes.
When conservative treatment fails, or when the child is experiencing adverse psychological effects, surgery may be indicated. Surgery for those with mild to moderate cases involves lengthening of the affected metatarsal with a lengthening bone cut or lengthening bone graft; when the toe tends to be normal we often leave that alone. In cases of severe difference in metatarsal bone length, slow distraction of bone is performed with a small external fixator after making a surgical break in the bone. External fixators are small metal frames that actually are on outside of foot but attached to bone. Patients are typically required to be non-weight bearing during recovery for approximately three months.
Once the bone is surgically repaired children go on to become active adults, usually with no restrictions. Wearing a normal pair of open toed shoes for the first time after the foot has been repaired can be a very emotional moment for sufferers and parents.
Get your child checked by a podiatrist as soon as you notice this condition so they can get treated as soon as possible. The last thing we want is our children crying "wee wee wee" all the way home! Click here to request an appointment!