Though some symptoms of Brachymetatarsia can be managed with non-surgical options like supportive shoes, orthotics, and activity modifications, some patients chose to undergo surgery to correct the condition. The aim of the surgery is to lengthen the metatarsal bone which can be done using Acute Lengthening or Gradual Lengthening with an external fixator called a Mini-Rail. The choice of the procedure depends on the length that is to be achieved. With Acute Lengthening the bony alignment is usually set during a single surgery. During Gradual lengthening the corrections are performed over several weeks or months and may involve 1-2 surgical procedures to apply and remove an external fixator device.

Indications / Candidacy

Brachymetatarsia is a congenital (present at birth), shortening of the toe, where there is a disturbance to the growth of the toe. It happens most commonly in the fourth toe, although it could affect any toe. The toe itself is usually of normal length, but the bone to which the toe attaches in the arch (the metatarsal bone) is short. It is sometimes described as a floating toe. It occurs more often in women than in men, and is often bilateral (both sides).

Good Candidates for acute and gradual lengthening to treat Brachymetatarsia may have:

  • Pain associated with the short toe
  • Difficulties with shoe wear such as rubbing and irritation of the shorter toe
  • Shorter toe causing functional limitations for walking/sports
  • Appearance of the toe (cosmetic and social impacts)

Treated Conditions

The Canadian Limb Lengthening Center offers a team of experienced surgeons, nurses and physiotherapists that make patients feel supported throughout their entire treatment process. Our ability to treat complex orthopedic conditions with a holistic approach gives our patients the best possible outcomes. We pride ourselves in providing highly specialized, expert care. To learn more about Brachymetatarsia follow the links below:



Surgical Technique

Arthrodesis can be performed either arthroscopically (with a camera) or with a traditional open approach. Arthroscopic fusions are done using two small incisions at the front or back of the foot. An open technique may be performed from the front, back or lateral aspect of the foot.

Acute lengthening with bone graft

If the toe requires lengthening of approximately 10 mm or less, it can be corrected using a bone-grafting procedure.


  • General or regional anaesthesia is given
  • The bone graft is then taken from your iliac crest (pelvic bone)
  • An incision is made on the short toe and the extensor tendons are lengthened in a Z fashion
  • The bone is then exposed and cut using a saw.
  • The short bone is then distracted by a spreader and the graft is inserted into the space.
  • The graft is held in place with a wire that transverse the toe. This wire also helps keep the other joints stable.
  • A rigid heel post-operative sandal is used post-operatively for walking on the heel.
  • The wire is removed from the toe about 6 weeks after surgery.

Gradual lengthening with external fixation

If the toe requires lengthening that exceeds 10mm, then gradual correction is done using an external fixator.


  • General or regional anaesthesia is given
  • 4 pins are inserted into the short toe, aligned with the axis of the toe
  • A small cut in the skin is made and the short bone is cut in the middle of the 4 pins.
  • An external fixator is placed on the 4 pins and 1mm of distraction is done under xray to ensure that it is functioning properly and that the bone is lengthening.
  • A K wire is then inserted into the toe from the top to stabilize the joint above the lengthening.
  • The incision is closed, and bandages are placed.
  • A rigid heel post-operative sandal is used post-operatively for walking.
  • This procedure can be done on both feet at the same surgery.

Lengthening starts approximately 1 week after surgery.  The patient has an allen key that they use to turn ( ¼ turn 2 times a day or as instructed) to lengthen the toe. Once the desired length is reached, turning stops and consolidation of the bony healing continues.  The device is removed once the bone is completely healed.


After treatment, the short toe is lengthened and has improved alignment with surrounding toes. These results give our patients a more comfortable and pain free experience, especially when walking in common footwear like sneakers or dress shoes. After the bone is fully consolidated and healed, the patient can fully weight bear on the foot. This surgery has very high success rates and our patients are very happy with their treatment outcomes.

Potential Complications

As with any surgical procedure, acute and gradual lengthening to treat Brachymetatarsia can have difficulties and complications. In most cases, our team of specialists can address these concerns without compromising the end results or outcome. Complications and side effects may include:

  • Infection (superficial or deep)
  • Pain (temporary or permanent)
  • Swelling
  • Delayed union, non-union or mal union of the bone
  • Over lengthening
  • Premature consolidation (for gradual lengthening)
  • Subluxation of toe
  • Stiffness of toe and arthritis
  • Metatarsalgia
  • Fracture of toe

Pre-Operative Care

  • An extensive medical history will be taken during your initial assessments
  • It is recommended that you stay active, eat a healthy diet, and stop smoking prior to any operation
  • Certain medications and vitamins may need to be stopped several weeks before
  • Discuss all medications and over the counter drugs with your surgeon
  • Use a calendar or agenda to organize your pre and post appointment dates
  • Make arrangements for personal care givers

Post-Operative Care

The toe lengthening surgeries are usually performed as outpatient surgery, meaning that the patient can go home on the same day. The recovery time after a brachymetatarsia surgery depends on the procedure performed and on the amount of lengthening required.

For acute lengthening, recovery time is approximately 3 months.  Patients are permitted to walk on their heel until 6 weeks after surgery and then they are encouraged to walk on their entire foot to help heal the graft.

For gradual lengthening with the external fixator, recovery time varies depending on the length desired and the speed of bony consolidation.  Typically, patients can expect to have the external fixator on their foot for 4-6 months. Patients are permitted to walk on their feet with special sandals during the lengthening phase and encouraged to increase their weight bearing to their foot once desired length is achieved. For this reason, both feet can be operated on at the same time.

Patients who will undergo this procedure with Acute Lengthening with Bone Graft should read:

Acute lengthening Brachymetatarsia P

Patients who will undergo this procedure with Gradual Lengthening with External Fixator should read:

Gradual lengthening Brachymetatarsia

Follow-ups after surgery

  • Patients will be required to attend all post-operative appointments
  • For acute lengthening your follow up appointments and repeat x-rays will be at 2 weeks, 6 weeks, 3 months and 6 months post-operatively
  • For gradual lengthening, your follow up appointments and repeat x-rays will at 1 week and then every 2 weeks until the desired length is achieved.  Once the length is achieved, follow up is every 4 weeks with x-rays until bony healing is complete

Case studies

26 year old girl with brachymetatarsus
22 year old girl with brachymetatarsus on right foot


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Highly specialized expert care at CLLC

At the Canadian Limb Lengthening Centre we offer complex deformity correction and limb lengthening surgeries performed by experienced surgeons with the most up to date technologies. When it comes to your care, and treatment of deformity and limb length discrepancy, our surgeons have extensive training and experience.