Brachymetatarsia: One-Stage Correction using a Cadaver Bone Allograft

by Al Kline, DPM1 , Endolyn Garden, BS, (Hons)2

The Foot and Ankle Online Journal 2 (5): 1

Brachymetatarsia is defined as congenital shortening of the metatarsal caused by premature closure of the epiphysis. The condition most commonly affects the fourth metatarsal of young and adolescent females. Correction of this deformity is either by callus distraction using an external fixator, or by one-stage surgical lengthening procedure using autogenous iliac bone graft. A case of brachymetatarsia is presented that is corrected by one-stage cadaver bone graft sterilized by the Biocleanse ® method. Advantages include complete incorporation of the graft and healing characteristics similar to autogenic bone grafting without the need to harvest graft material.

Keywords: Brachymetatarsia, autogenous, allogenic, bone graft, allograft, biologics, Biocleanse® sterilization process

This is an Open Access article distributed under the terms of the Creative Commons Attribution License.  It permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ©The Foot and Ankle Online Journal (www.faoj.org)

Accepted: April, 2009
Published: May, 2009

ISSN 1941-6806
doi: 10.3827/faoj.2009.0205.0001


 
The exact etiology of brachymetatarsia is not known. It is thought to be either idiopathic congenital, acquired, or associated congenital. [3] The idiopathic congenital etiology, which refers to the early closure of the epiphyseal plate, is thought to be the most common. The associated congenital etiology is accompanied by other conditions such as Albright’s Syndrome or Down’s Syndrome and parathyroid alterations. Acquired etiology refers to the early closure of the epiphyseal plate after suspected trauma. [3]

A variety of measurements have been described to define brachymetatarsia of the fourth metatarsal. [2,3,4,7] In 2003, brachymetatarsia was diagnosed “when one metatarsal ends 5 mm or more proximal to the parabolic arc”. [7]

In 2004, a morphofunctional study described a more specific measurement called the “angle of fourth metatarsal shortening or second-fourth angle” to quantify the definition of brachymetatarsia. [3] Brachymetatarsia is defined as a second-fourth angle of less than 52.2 degrees in males and 50.5 degrees in females. [3] Using both techniques, in our case report, the fourth metatarsal measured more than 5mm of shortening from the parabolic line and the second-fourth angle is less than 50.5 degrees respectively (45.2 degrees). The parabolic difference is a 10 mm shortening. (See radiograph Fig. 2)

It has been reported that the fourth metatarsal is more likely to be affected by this condition, although many studies vary in their reports. [3,4,10] The majority of cases are seen in females (98:4 female to male ratio respectively) and 72% of these cases occur in both feet. [4] Brachymetapody, a noticeable shortening of the toe, can also present with brachymetatarsia.

Conservative treatments include using metatarsal padding within the shoes. [1] Digital padding and toe splinting may also be attempted. When this is ineffective, surgical correction may be indicated if the patient is experiencing metatarsalgia or have difficulty getting shoes to fit properly. These patients may develop painful calluses, or have a dislocated digit (also known as a “floating toe”). [4] Many patients also express discontent with the appearance of the foot, but this alone is not usually an indication for surgery. [1] However, having the deformity may cause the patient to be overly self-conscious which can lead to psychological issues such as depression. This is particularly important because the abnormality usually presents between the ages of 5 and 14 years in young females. [4]

When surgery is performed, the desired result is to relieve pain and restore functionality. [5] The two methods used most often to correct this condition are gradual distraction using an external fixator, and one-stage surgical lengthening using a bone graft. Gradual distraction involves surgically placing an external fixator on the metatarsal to be lengthened. One-stage lengthening of the metatarsal involves using allograft or autogenous bone, and interposing the graft within the metatarsal. When using an autogenous bone graft, the bone is harvested from the patient’s own body and transplanted into another part of the body. A common site to harvest autogenous bone is the iliac crest. Other sites may also be used, such as the ribs, calcaneus and fibula. [12] An allograft is “any tissue harvested from one individual and implanted into another of the same species [13],” and is used as a substitute for autogenous bone. The allograft bone used in this case were prepared by sterilization and disinfection methods that include gamma irradiation and a low temperature chemical sterilization method known as BioCleanse®. [11]

Case Report

A 13 year old female presents to the office with pain and discomfort involving the left fourth toe. The toe ‘rides up’ on the foot and interferes while wearing closed shoes. (Fig.1)

Figure 1 Initial presentation of brachymetatarsia of the fourth metatarsal.  Typically, the 4th toe is short and contracted due to the immature growth and congenital shortening of the fourth metatarsal at 13 years age.

Radiographic evaluation reveals a congenitally short fourth metatarsal. (Fig. 2 A and B) The patient tried modifying her footwear, but with limited success. At initial visit, the patient was fitted with a digital Budin type splint in an attempt to help plantarflex the digit and eliminate pain. We also initiated dorsal digital padding to protect the toe while in the shoe. Most conservative measures were inadequate and we opted to bring the patient to surgery in order to correct the brachymetatarsia and lengthen the toe.

 

Figures 2A and 2B Radiographs show a typically short fourth metatarsal.  Notice how the fifth toe has rotated in a digital varus orientation.  All epiphyseal growth plates have already closed. (A)  The second-fourth angle measured 45.2 degrees which significantly less than the normal parameter of 50.5 degrees (B) 

The patient has an allergy to Suprax® and is taking Ibuprofen for pain and swelling. The patient has no medical conditions and is young and healthy.

Surgery was discussed with the patient and mother. We described the two options for surgery including callus distraction with an external fixator or a one stage procedure including inter-positional bone graft. Because of her age and health status, we opted for the one stage lengthening. We also described the various types of grafting techniques including autogenous bone grafting from the patient’s own iliac crest to using allogenic, cadaver sterilized bone graft.

Complications of this procedure were discussed including failure of graft material, vascular compromise to the fourth toe and metatarsophalangeal joint stiffness. Two weeks before her surgery, she was asked to manually place distal traction on the toe every night for about 5 to 10 minutes daily.

Surgical Technique

The patient was brought to the operating room. Under sterile technique, a small linear incision was made along the dorsal mid-shaft region of the fourth metatarsal. The extensor tendon was identified and lengthened by standard z-plasty technique. (Figs. 3 A and B)

 

Figures 3A and 3B A small linear incision is oriented along the long axis of the fourth metatarsal. (A)  An extensor z-slide tenotomy is performed to prevent dorsal contracture of the fourth toe during the metatarsal lengthening. (B)

Using blunt and sharp dissection technique, the mid-shaft region of the fourth metatarsal was identified. A small surgical bone saw was used to perform a transverse osteotomy through the metatarsal.

Using a laminar spreader, 2 cm of distraction is placed between the distal and proximal portions of the fourth metatarsal. It is important to gradually place increasing distraction stress through the metatarsal. (Figs. 4 A – C)

  

Figures 4A, 4B and 4C  The mid-shaft region of the fourth metatarsal is exposed taking care to not strip the periosteum from each side of the bone. (A)  A small bone saw is used to perform a transverse osteotomy perpendicular to the long axis of the fourth metatarsal. (B)  A laminar spreader is then used to place a distractive force along the long axis of the fourth metatarsal.  The laminar spreader is slowly spread apart over an hour to eliminate any incidence of vascular compromise. The metatarsophalangeal joint will become inherently stiff during the distraction process.  Plastic deformation of the surrounding tissues is promoted by gradual stress distraction.  (C)

This allows for gradual lengthening of the neurovascular structures of the fourth toe and promotes a gradual plastic deformation of the tissues.

The metatarsal is gradually lengthened over 30 minutes to 1 hour. During this period, the graft can be shaped and prepared for implantation. It is important to realize that the fourth metatarsophalangeal joint will become inherently stiff and rigid during this process. The elastic properties of the surrounding tissues including the joint capsule will slowly begin to deform and relax. A too rapid distraction will cause soft tissue contracture leading to vascular spasm, so gradual distraction is recommended.

During the hour of controlled distraction, the cadaver graft is prepared. It is important, when preparing the graft, that one take bone approximating the thickness and length of the metatarsal. We chose to use a humoral graft and cut a 20 mm section to approximate the size and shape of the metatarsal. Although the metatarsal gap measured and desired length is measured at about 10 mm on radiograph, a larger graft is recommended to be initially used. The graft is easier to handle and drill, then can be remodeled to a smaller size prior to insertion.

Once the graft is to the desired shape, a .062mm Kirschner wire is used to drill a hole along the long axis of the graft. This is called pre-drilling the graft. This graft was completely cortical. Pre-drilling the graft will allow for easier placement in the final stages of the operation.

Once the graft is prepared, blood is drawn from the patient and a platelet and white blood cell concentrate is prepared and placed on the back table. The graft is then placed in the concentrate slurry while completing the distraction process. (Figs. 5 A – C)

  

Figures 5A, 5B and 5C  The allograft is cut directly from a hard cortical section of humeral cadaver bone. (A)  Once the bone is shaped, the graft is pre-drilled along the long axis of the bone to prepare for interpositional insertion of the graft to the fourth metatarsal. (B)  While the laminar spreader is distracting the bone, once the graft is ready, it can remain in the platelet and white blood cell concentrate taken from the patient’s own blood. (Biomet® Bioorthologics GPS® III)

When the distraction process is complete, the graft is now ready for placement. This stage can be technically challenging due to the persist tightness of the confined space. The graft often has to be re-shaped or slightly shortened for proper placement. That is why it is important to properly measure the distance of distraction prior to graft placement.

At this point the laminar spreader is removed and the wire is reverse drilled along the distal portion of the metatarsal through the digit. The bone must be angled and care must be taken to not plantarflex the digit too much once pinned.

Once the k-wire is in proper alignment, the graft is carefully inserted within the metatarsal. The most challenging aspect of this surgery is aligning the pre-drilled hole with the k-wire and through-drilling to the most proximal segment of the fourth metatarsal. (Figs. 6 A-C)

  

Figures 6A, 6B and 6C  The laminar spreader is removed after an hour of distraction.  The mini c-arm is used to determine the proper amount of distraction to attain the proper metatarsal length and parabola. (A)  The k-wire is directed distally first.  The bone is angulated and then drilled through the fourth digit. (B)  The graft is then interposed within the fourth metatarsal, drilled and stabilized with a .062 k-wire.  (C)

Once the graft is in place, the remaining platelet and white blood cell slurry is lavaged into the wound prior to closure. A small Jergen’s® ball is placed on the k-wire and the foot is then dressed in a smile gauze dressing and placed non-weight bearing in a posterior leg splint. (Figs. 7 A – C)

  

Figures 7A, 7B and 7C  Once the graft is securely in place, the patient’s own platelets and white blood cells are lavaged into the wound. (A and B)  The pin is protected with a Jergen’s® ball at the end of the k-wire and closed prior to application of dressings and a posterior leg splint. (C)

After 2 weeks in a posterior splint and when the sutures are removed, the patient is placed in a short leg fiberglass cast for an additional 6 weeks. The entire immobilization period is about 8 weeks before partial to full weight bearing can resume. Radiographs performed at the end of 8 weeks reveals solid and complete incorporation of the graft along the metatarsal shaft.

The patient has now been seen over the last year without pain or complication to the graft. The toe actually moves without any stiffness to the metatarsophalangeal joint on range of motion. She is very pleased with her surgical outcome. (Figs. 8 and 9)

Figure 8   At 8 weeks, the bone graft shows signs of bone interposition and callusing. Deformation stress is noted along the proximal half of the 4th metatarsal, but does not compromise the overall shape of the metatarsal.

Figure 9  After 6 months, the patient is very pleased with the restoration of metatarsal and toe length.  There is excellent fourth metatarsophalangeal joint range of motion without pain or discomfort.

Discussion

The author’s have found the use of an allogenic bone graft to have the same characteristics and properties as autogenous bone in one-stage metatarsal lengthening procedures, but without the need to harvest bone graft from the patient. They both have osteogenic, osteoconductive and osteoinductive properties. [18] Osteogenic properties refer to the properties that promote the synthesis of new bone. Osteoconductive properties are those properties of the graft that provide framework where the formation occurs. Finally, osteoinduction is the ability of the graft to “stimulate the host precursor cells to form new bone through differentiation into chondroblast or osteoblast”. [18] One of our concerns before surgery was whether the graft would incorporate as normal bone.

As previously mentioned, there are two techniques commonly used to treat brachymetatarsia: gradual distraction with external fixation and one-stage lengthening using bone grafts.

The first method involves applying an external fixator that is used to gradually lengthen the bone. This is achieved by surgically placing the fixator into the metatarsal that is to be lengthened. About a week post-operatively, the lengthening begins at a rate of ¼ mm four times per day for a total of 1 mm per day. [2] This may take place over a period of several weeks. [5] After the desired result is achieved, the fixator remains static for twice the amount of time it took to perform the distraction, during which time the patient remains non weight-bearing. [5] The patient typically can tolerate full weight bearing once the fixator is removed. [2] The reported advantage to this technique is the soft tissues and neurovascular structures are lengthened at the same time the bone is being lengthened. This tends to maximize the ability of the metatarsal to lengthen. [2]

There are complications that could arise when using gradual distraction over a longer period, but this appears to be more associated with the external fixator. Some of these include hyper-pigmentation around pin sites, pain during distraction, stiffness, decreased range of motion, scarring, deformities, joint dislocation, prolonged bone consolidation and pin-track infections. [1,2,5,8]

One-stage lengthening is a process where autogenous or allograft bone is grafted to lengthen the metatarsal. The advantages of this procedure include a shorter bone consolidation period, smaller incision, and less morbidity. [8,10] Some of the disadvantages and complications involved with autogenous bone grafting include technical difficulty, neurovascular damage, small gain in length, and donor site morbidity. [8,10]

It appears that gradual lengthening in the operating room using a laminar spreading and applying distraction stress gradually over 30 minutes to 1 hour will not cause vascular compromise.

A number of studies have been reported on the viscoelastic properties of the surrounding soft tissues during metatarsal lengthening. [4,10] Stress relaxation will promote a lengthening of soft tissue when gradually performed, even in a relatively short period of time. A too rapid distraction of surrounding tissues will cause more contracture and vascular spasm with tissue compromise. Using this gradual distraction technique with a simple laminar spreader, we were able to achieve over 10mm of lengthening within an hour without vascular compromise to the toe.

Allogenic and autogenous bone grafts have similar properties including bone healing characteristics and incorporation rates. The process of bone healing occurs in four stages; inflammation, soft callus formation, hard callus formation and bone remodeling. During the first stage, there is bleeding at the site which results in a hematoma. Inflammatory cells then penetrate the hematoma to fight infection, secrete cytokines and growth factors and promote clotting. In the next stage chondrocytes and fibroblast produce a soft callus to provide mechanical support and a template for the bony callus. The third stage is where most of the osteogenesis occurs. There is a high level of osteoblastic activity and formation of mineralized bone. The soft callus is slowly removed and revascularization occurs. [20] In the final stage, remodeling of the bone occurs, blood circulation to the area improves and the bone becomes compact. Complete bone healing takes 6 – 8 weeks, although factors such as movement, smoking, poor nutrition, age and disease can affect the healing rate. [21]

An advantage to allogenic bone grafting is that there is no need to harvest bone from the patient, thus there is no donor site and a second surgery site. Having a second surgery site, or in this case, a donor site can potentially make surgery more complicated, and increase the risk of infection as well as creating increased pain along the donor site. It is very common for the donor site to be more painful after surgery than the recipient site, especially at the iliac crest. With allogenic bone, there is no donor site pain, no type matching or rejection, and the allogenic bone can be pre-shaped to decrease the surgery time. [16]  To our knowledge, this is the first reported successful correction of brachymetatarsia with complete incorporation of a cadaver allograft using the Biocleanse® sterilization process.

The BioCleanse® Sterilization Process

The BioCleanse® sterilization process is used by Regeneration Technologies to prepare allograft tissue for surgical uses. These implants are used in spinal, sports medicine, general orthopedic, cardiovascular, and dental surgeries. [17] Before any tissue is used, a medical and social history of the donor is obtained from the donor’s family. The tissue is then inspected and screened for diseases (such as HIV and hepatitis). [15] Upon approval, the tissue enters into the automated sterilization process. [14] In the first step of the sterilization process blood, lipids, and marrow are removed from the bone via a vacuum/pressure process to reduce the risk of immune response in the recipient. Next, chemical sterilants are used to eliminate pathogens. This process is designed to go deep within the tissue matrices to eliminate pathogens such as bacteria, viruses, and fungi. Finally, the germicides are removed, and the tissue’s biocompatibility is preserved in the process. [13] In order to ensure a low contamination rate, surface sterilization is incorporated during final packaging through low doses of gamma irradiation or hydrogen peroxide gas plasma. [13]

Mroz, et al., in analyzing the biomechanical properties of allograft bone treated by the sterilization process concluded “Sterilization of allograft bone with Biocleanse® does not significantly alter the mechanical properties when compared with untreated samples. The effect of this sterilization process on the osteoconductive and osteoinductive properties of allograft bone must be determined.” [22]
In this case report, it appears the allograft incorporated well within the surrounding bone and tissue and provided this patient with adequate bone lengthening without the need for autogenous bone harvest.

References

1. Gilbody J, Nayagum S: Lengthening of the first metatarsal through an arthrodesis site for treatment of brachymetatarsia: A case report. Journal of Foot Ankle Surgery. 47 (6): 559 – 564, 2008.
2. Houshian S, Skov O, Weeth R: Correction of congenital brachymetatarsia by gradual callus distraction. Scand J of Plast Reconstr Surg Hand Surg. 36 373 – 375, 2001.
3. Pedro V. Munuera Martínez PVM, Guillermo Lafuente Sotillos G, Domínguez Maldonado G, Luis Salcini Macías J, Martínez Camuña L: Morphofunctional Study of Brachymetatarsia of the Fourth Metatarsal. J Am Podiatric Assoc . 94 (4) 347-352, July-Aug. 2004.
4. Goforth W. et al Brachymetatarsia of the Third and Fourth Metatarsals. J Am Podiatric Assoc. 91 (7) 373-378, 2001.
5. Wilusz P, Van P, Pupp GR: Complications associated with distraction osteogenesis for the correction of brachymetatarsia: A review of five procedures. J Am Podiatric Assoc. 97 (3) 189 – 194, 2007.
6. Allmendinger A, Yeghiayan P, Perone R, St. Vincent’s Medical Center in New York City: Case of the month. diagnostic imaging 31( 1) [online] Accessed February 7, 2009.
7. Kim HT, Lee SH, Yoo CI, Kang JH, Suh JT: The Management of Brachymetatarsia. Journal of Bone Joint Surgery. 85B (5) 661 – 665, 2003.
8. Kim J, Baek GH, Chung MS, Yoon PW: Multiple Congenital Brachymetatarsia: One-Stage Shortening and Lengthening Procedure Without Iliac Bone Graft. Journal of Bone Joint Surgery. 86B (7): 1013 – 1015, 2004.
9. Bone Graft Alternatives. North American Spine Society [online]Assessed February 15, 2009.
10. Baek GH, Chung MS: The Treatment of Congenital Brachymetatarsia by One-Stage Lengthening. Journal of Bone Joint Surgery. 80B (6): 1040 – 1044, 1998.
11. (2003) BioCleanse Tissue Sterilization :Sterilization Validation. Regeneration Technologies, Inc. [online] Accessed March 21, 2009
12. Finkemeier C. Bone-Grafting and Bone-Graft Substitutes. Journal of Bone Joint Surgery. 84A (3): 454-463, 2002.
13. Bostrom MPG, Seigerman DA: The Clinical Use of Allografts, Demineralized Bone Matrices, Synthetic Bone Graft Substitutes and Osteoinductive Growth Factors: A Survey Study. Hospital for Special Surgery, 2005 [online] Accessed March 21, 2009.
14. No author: A New Standard for Tissue Sterility. Regeneration Technologies (2006) [online] Accessed March 21, 2009.
15. No author: From Donation to Implantation. Regeneration Technologies (2006) [online] Accessed March 21, 2009.
16. No author: Biologics vs. other materials. Regeneration Technologies (2006) [online] Accessed March 21, 2009.
17. No author: Biologics Implants. Regeneration Technologies (2006) [online] Assessed March 21, 2009.
18. Sen MK, Miclau T: Autologous Iliac Crest Bone Graft: Should it Still be the Gold Standard for Treating Nonunions?. Injury. 38 (1) S75-S80 2007.
19. Malay DA: Closer look at bone graft substitutes. Podiatry Today (18) 1 Sept, 2005 [online] Accessed April 15, 2009
20. Schindeler A, et al Bone Remodeling During Fracture Repair: The Cellular Picture. Seminars in Cell & Developmental Biology 19: 459 – 466, 2008
21. No author: Bone Healing (2008, May 26). American College of Foot and Ankle Surgeons [online] Accessed April 15, 2009.
22. Mroz TE, Lin EL, Summit MC, Bianchi JR, Keesling JE Jr, Roberts M, Vangsness CT Jr, Wang JC: Biomechanical analysis of allograft bone treated by novel tissue sterilization process. Spine Journal 6 (1): 34 – 39, 2006.


Address correspondence to: Al Kline, DPM
3130 South Alameda, Corpus Christi, Texas 78404.
Email: al@kline.net

Adjunct Clinical Faculty, Barry University School of Podiatric Medicine. Private practice, Chief of Podiatry, Doctors Regional Medical Center. Corpus Christi, Texas, 78411.
2  Texas A&M Graduate (Hons), Corpus Christi, Texas, Incoming first year student, Barry University School of Podiatric Medicine.

© The Foot and Ankle Online Journal, 2009

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129 responses to “Brachymetatarsia: One-Stage Correction using a Cadaver Bone Allograft

  1. Michelle Sodoski

    I am writing on behalf of my daughter Hannah. She is a beautiful young 15 year old girl that has Brachymetatarsia. In the past 2 years she has been experiencing pain in her feet. I have taken her to a podiatrist and they claim nothing can be done. My daughter has diligently looked up information to find a way to have this rectified. She came across your web site and I was wondering if you know of anyone in the Eastern part of the US that practices your same method. If you could please send me any information that would help me in finding someone I would be forever grateful. Sincerely, Michelle

  2. Michelle,

    I have sent you a personal email.

  3. Hi Al,

    Nice article. The result looks great. I used to use cadaveric bone in the late 90’s for this procedure. Did about 20 of them but had a 5% nonunion rate that had to be redone with autograft. Since then I have been using calcaneal grafting on over 140 cases and have had one nonunion. It typcially takes the distal end the longest to heal and the cases where I had non-unions are about 14-15 mm. These patients were in their late 20’s and early 30’s so bone healing should have benn good. But alas, it was unaaceptable to me so I switched back to autografting.

    Thanks for the nice article.

  4. Dr. Lee,

    It would be great if you could report your results including techniques, complications, non-union rates , etc. You have a great case study group of 140 cases. This type of case study information would make for a very intersting journal article. Hope you would consider that contribution to our journal.

  5. christina of yonkers,ny

    Im 20 years old and I have this brachymetatarsia and I seen doctors that said they cant help me and I have two children that dont have this but i would love to marry the man of my dreams one day but i feel that i can not becaue of my feet I would love it someone in new york can help me

    • Im 19 and in New Rochelle New York, 10 minutes from you! I just came to college here from Florida, i have brachymetatarsia too on both feet! I want to find a man thats comfortable with it too! All my boyfriends have ignored they ever saw it which sucks worse, or they ignore when i try and slip it in conversations when im in a comfortable mood and want to pretend i dont care. They get more uncomfortable than i do! Beaches suck for me. All my friends are pretty and i am too but now of days guys are growing fonder of toes! How can a man have better toes than me? thats horrible. I need an esteem booster. Todays the first day i found out the name of my condition. i want surgery so bad but im broke and so is my family. You think a loan will get granted? or maybe just the lotto! lol. Springs coming up. I can go back home but i literally passed on that and am guna stay here for my first college spring break. sad sad sad. Anyways write me back on a response or anything you have done to get through this problem we both share! lets help eachother! = )

      • hi eileen. did you get any response? i dont know how this works, i wanted to email you without anyone seeing my message. i also have the same case as you have, no money, really want to have that surgery. i just wanted to know if you heard something from someone and if you have an idea on how much its going to be. same as you, i really want to have that surgery. =(

        also, i just found out today about my condition and how its called… thank you Eileen.

      • when I red this I thought somebody was talking about my life!!!

  6. my daughter melina had the above surgery with Dr kline ,every peace of information mention above is exacly how it was explain to me and step by step the doctor and his wonderfull staff inform me how everything was plan and the results come out just like he explain with no complications and minor discomfort ,anyone with this condition should be evaluated sincerily leticia loeza

  7. I have this same with both of my feet and would like to have a life changing surgery like this, it looks very good.
    Does anyone know if there are specialists for this in Europe? I live in the UK but could easily go to any other country in Europe to have this done.

    • Hi, I live in Belgium and as far as I know, I’m the only one in my country who has this condition. I think there are more people with Brachy because everyone is hiding their feet so you just can’t see. Anyhow, I do want that surgery too because it is ruining my life also! So, is there anyone whit brachy who lives in Belgium or Netherlands?

    • Hi, Kath! I’m from Russia and we have such specialists. I have the same problem with my feet. Now I stay at a hospital and my feet are already at the last stage of fixing. If you are still interested please write to my e-mail I’ll give you information.

  8. I am 28 years old and have been living with this condition as long as I can remember. I deparetely would like to have corrective surgery. I would also like to get info on any specialists in the southeastern U.S. area that practice this particular surgery method.

  9. I am 15 years old and currently living with this condition. I never wear open toed shoes and i have grown very self consious because of it. I came across your website and am very interested in this procedure. i wanted to know if you knew of anyone in the south eastern part of the United Staetes. If you could get back to me I would be very grateful! Sincerely Rose

    • Hi rose, im Ashton. I’m fourteen and currently live in arkansas with this condition. I always wear converse or tennis shoes and, when the weather is nice and its time for a swim, i have to wear pool shoes because i am THAT self consious about it. I didnt know about this until like just now and now im glad im not the only one

  10. i have the following condition and i was just wondering as i live england is there any surgons that can do this opperation or will i have to travel to america and get it done as it upsets me that i can not wear sandles as i am very embarrsed. There for i do not go out much in the summer. this is really ruining my life. is there any thing you could d 2 help me . x

  11. I have been searching for a site that has a similar case like my feet and i found this.In the summer its really embrassing to wear sandals or show anyone your feet .its really depressing to see all the nice feet and yours are not .can i get any help

  12. I have the exact same condition described above. I am 21 years old. I am interested in having this surgery done. Can you recommend a good surgeon in the NY/NJ area?

  13. my left feet has the condition of brachymetatarsia (4th toe is very short).I am 16 years old and very ashamed of it.Is this surgery possible at this age of mine?(I want to be sure that it’s not early).Also I would be greatefull if you recommend a surgeon who can make this surgery in Europe area like UK.Please contact me as soon as possible because this is very important for me.

  14. I too have this condition, with me, it affects both feet and my third and fourth toes. I am 22 years old and it is very embarrassing I really would love to have corrective surgery for this. I live in Ohio…does anyone know of any specialists?

    • Hello, Ashely
      I too have the same condition as you. My third and fourth toe on both feet are like this. Im 18 and a freshman in college, it’s summer time again, and just like you its very very embarrassing to show my toes. I dont live in Ohio but i do stay in Missouri which is not that far. And i was wondering if you found any specialists in the Midwest area?

      • Sheila Dawson

        hello ashley, my name is sheila i am 42 yrs old a mother of 3 two boys and one girl. my youngest son has this condition and this is all new i came across this medical condition in the feet BUT the only difference is my son and myself have this in our hands too!!!! i get so self conscience about my feet my hands and the world can be a very rude place…… i’d love to speak to someone that has experienced the same feeling’s as myself. 620-222-2446 I LIVE IN KANSAS i am so interested in haveing my toe surgically fixed, that would mean almost everything to me.

  15. It sounds like I have this condition as well which I just discovered today actually has a name, brachymetatarsia. I’m 32 yrs old and I noticed it around the age of 11 on my left foot and grew very self-contious about it since then. However maturity has allowed me to overcome the embarrassment of it and I do ocassionally wear open toe shoes though I never feel completely confident about my feet. Aside from the vanity issues I noticed that over the past several years my balance has been completely off to where I can’t even walk straight within an 8 feet distance without leaning to the left. Often times when I am just standing for a long period of time I have to catch myself from falling. I wonder if this has anything to do with the shortness of my fourth toe on the left foot.

  16. You can find out by having a simple x-ray to diagnose brachymetatarsia. See your foot specialist.

    • Dr. Kline,

      I have Brachy on my 3rd toe, right foot. I was wondering if you knew any surgeons in Michigan that do the one stage surgery using donor bone as referred to in your article? I don’t want to have 2 surgery sites. I only have a short metarsil, not a short toe bone and I only need around 6 to 7 mm. Thaks so much!

      • I am also wondering if there are any specialists in the Midwest United States who perform the one stage surgery. I am 29 and just found out that this is a condition that is fairly common and can be corrected! I am overjoyed! :) I looked into a doctor in California, but he is currently only treating in-state patients due to the post-op care. Can someone lead me in the right direction? I would be so grateful. Thank you!

  17. I had my fourth toe on my right foot done a couple of years ago. The doctor took part of a bone from the fifth toe and placed in the fourth. The arc of the foot toe looks good except for scarring but there is little movement in either toe now. I want surgery on the left foot soon probably in the next month and wondered if you know of any surgeons that I could go to in the Raleigh/Durham area in NC for a consult? I’m not interested in the external process that you have to turn. We would love to get Dr. Lee to perform the surgery but the 12 weeks that would be required as non-bearing would probably not work for me. Is laser surgery an to reduce some of the scarring left on the right foot?

  18. Dr. Kline,
    I’m 28 years old and i’m writing to u from Romania/Europe. I have the same problem as everyone here seems to have, on both feet (4th metatasian). I’ve seen a doctor in Romania but the only option he gave me was an external extrator. I have to admit that the posibility of having a one time extraction is much more attractive. I have also found some information about a mini internal extractor that does not involve such a big discomfort than the external one, but my question to u, is if you could indcate an european doctor that is performing the same interventions as you. With many thanks in advance, Alina

  19. Wow ever since I was ten years old I started noticing my toes were different then all the other kids noticed and ever since 8th grade when I was wearing sandles a kids said out in found of everyone “you have weird feet” that completly brought me down and I stopped wearing fill flops or anything open toed I was too affraid. I am now 24 years old and I’ve decided to forget it and live with it. I have learned to not care about what people think anymore if they have something to say then they are just rude and a waste. And when it comes to relationships I don’t care if my boyfriend doesn’t like my toes then so be it he wasn’t the right one. But I am thankful to have a boyfriend that doesn’t
    ind and loves me for who I am and not my feet lol. I just found out today what this condition is called and never realized how many people there have the same issue as I do. It makes me feel even better. Glad to know I’m not alone :))

    • Amen I too have been living with this condition for the last 33 1/2 years but am also learning to live with it. Read psalm 139:14 I believe:) It will help you get through. Take care and GOD Bless.

  20. Lil hope for those people out there not looking to do surgery. I’ve had this since a child, now 33. I am married with 3 kids. I run a couple marathons a yr (42.2km) and looking to do triathlons.

    The point… life goes on… don’t beat yourself up.
    I go the the pool sometimes and the beach. Sure I don’t advertise it, but I still can manage.

    If you can afford the surgery, by all means do it, but if you can’t, don’t worry about it. And trust me, you’ll find the right person that won’t mind your toes. Not everybody is superficial.

  21. Anyone knows of a doctor who does this surgery I have brachy on my left food I live in knoxville tn I saw a doc before all he suggested was to cut it off

  22. There are many people with Brachymetatarsia. And unlike 10 years ago, there is more information. People who have had surgery and those who choose not to have blogged their experiences. They offer a wealth of information.

    Just search for them, they are out there and perhaps they can help in your journeys.

    http://brachymetatarsia.blogspot.com/

    http://www.facebook.com/group.php?gid=4682262043&v=wall

    http://en-kort-en-lang.blogspot.com/

    http://brachymetatarsia.mywowbb.com/forum4/213.html

    http://midedocorto.wordpress.com/

  23. I’m 14 yrs. old and I’m in tears right now because I’ve finally found what’s wrong with me! My left foot looks exactly like the picture above. I’ve had it ever since I could remember. My parents told me I was born with it, but I refused to believe it and thought I must’ve jammed my toe when I was a baby or something. My parents and family members act like everything’s okay with it and except me for who I am. I obviously don’t think it’s normal and I am extremely self-conscious about it. I hide it from all my friends because I find it to be weird. I NEVER wear flip flops or sandals and I’m forced to wear tennis shoes, flats, etc. I wear socks ALL the time. I live in a small town in Virginia, US and I really needa know more about this surgery. Summer is coming and I want to finally be able to be comfortable on the beach and at the pool !

    • hi, im ashton. i am fourteen and i suffer from the same problems as you. do you have a facebook to where we can contact each other?

  24. After initially writing this article 2 years ago, I have performed a number of metatarsal lengthening procedures using cadaver bone grafts. However, in 1 case in particular, the graft did not fuse and it dislocated after pin removal. This patient returned to surgery and I had to remove the graft and use Iliac bone graft and a compression plate to correct the deformity. This technique is extremely difficult, especially using a laminator spreader to place the graft using a single axis wire. With this said, in the right hands, this procedure should probably be augmented with a secondary fixation device such as a compression plate to prevent the risk of graft subluxation. Thanks for all your posts and bringing brachymetatarsia ‘out in the open’.

    • Hi Dr. Kline,

      I saw on Dr. Lee’s website that he has now performed over 250 cases and averages 3-4 per month. How many cases have you performed? Do you know of any other podiatrists that have performed as many cases as Dr. Lee?

      Where are you located? Do you have a website so I can get further information?

      Thank you for your time,
      Mita

      • Dr. Lee has now done over 350 Brachy surgeries. There is no other podiatrist in the US who has done this many. He does not use a cadaver bone. He uses a bone graph from your very own heal for the one-stage correction. This means you’d have 2 incisions. (Insurance sees this as two procedures.) But they are done in one sitting.

        I have Brachymetatarsia and have done my research.
        I have a blog that I am composing, but it will not be available till the end of summer 2011. It will be thee most informative Brachy Blog available so far.

        Good luck with your research!

        Blessing, Luna

  25. I have not performed anything close to 250 procedures, and I have personally asked Dr. Lee to publish an article on this site concerning his results. Unfortunately, he is not privy to sharing any of his results or techniques. I’m almost sure that Dr. lee uses a one-stage lengthening technique, but that is about all. There is no mention of statistical results with his procedures. He advertises “cosmetic” foot surgery and placing incisions on the foot that are not typically on ‘top’ of the foot as in traditional bunion and hammertoe surgeries. He advertises most of his results through patient testimonials only. I must point out that many surgeons have been placing incisions to perform bunions and hammertoes (along the plantar medial foot for the bunion and a plantar or oblique incision on the toes) for many years, Dr. Lee has put a trademark on his technique. My advice is to seek a medical opinion concerning your foot with a qualified foot and ankle surgeon. Dr. Lee probably has more experience due to number of procedures he has performed, but without solid evidence or results (ie lengthening results, range of motion of affected digit, patient satisfaction, nonunions, patient complications, etc.) we are left in the dark as to whether a one-stage procedure is superior to callus distraction using an external fixator.

    • Thank you for your response Dr. Kline. It was very informative and helps guide me in the right direction. I actually had the external fixator many years ago and the desired length wasn’t fully achieved (only 60% of goal). I also lost range of motion and suffer from even more pain since the procedure.

      Could you please point me to your website or contact information so that I could possibly set up an appointment with you for a consultation?

      Are there any qualified foot and ankle surgeons that you could refer me to that are in Texas?

      Thank you for your time,
      Mita

      • Al Kline DPM

        There are many qualified foot and ankle surgeons here in Texas that could help you. I’m in South Texas. You may want to begin locally and then work out from there. Good luck.

    • Hi Dr Kline,
      I did have the surgery done with Dr. Lee. It’s been 5 months post op and im still having trouble with my foot. It’s going to take a while, but I’m keeping my fingers crossed that the swelling goes down. My heel is what is giving me the most trouble at this moment. His forum is offline, so I can’t really read about how the other surgeries have gone, but if anyone has any questions, I’ll be more than happy to answer.

      • Beth,
        Are you blogging your experience online? If so I’d love to see/read it.

      • Hi Beth,

        I would really love to hear more about your experience. When were you able to start walking again? When you say you have trouble, is it range of motion or just pain? How much have you recovered – 70%, 80%? What has Dr. Lee said about you still having trouble 5 months later? I know he claims that you can start walking again in normal shoes at 12 weekes.

        Would you be willing to share your before/after pictures? I have brachy on both of my feet. I had surgery with an external fixator years ago but I didn’t get the desired length. I was told that the reason was because my metatarsal was lengthened but the actual toe bone was also short and had to be lengthened separately. Is that the same case with you?

        Mita

      • Hello Beth,
        I am contemplating getting surgery with Dr. Lee but I am very nervous and I am feeling like I will be disabled for such a long time. How were your results? Are you still in pain?

      • TP,

        I too had surgery with Dr. Lee and you can read about my experience below.

        You need to understand several things. First, the one stage surgery extends the bone by “creating” a new bone from your ankle. As a result, the healing time can differ from person to person depending on their ability to heal bone. Do keep in mind that bone does take several months to heal. Healing is also affected by the level of attention and care you follow up on. You are instructed to keep your foot elevated as much as possible as well as icing it down. I was able to do this even in my job. People also have different tolerance to pain. What is agonizing to some, may be discomfort to others.

        In my case, the ankle pain was minimal. However, I did follow the instructed icing sessions. I never took any of the prescribed pain medication past my 7th day and that is considering that I was not at home and even had to fly for several hours before getting home. From time to time, I did occassionally take some over the counter ibuprofen to help with occassional swelling when using the ice packs. If I recall correctly, only the first week was true discomfort.

        It is not an easy surgery but if you do your research, you will come to find that the alternative ways are not easy either and they all have pros and cons.

        You need to decide how important it is to get this surgery and if your current lifestyle can support it. If you are only doing it for aesthetics, then do spend time thinking about it. In my case, my bone was so short that it would cause pain due to the unevenness. That pain is what motivated me to get the surgery and it is now gone.

        Don’t be nervous! From conversations with the staff, i’m told that Dr. Lee performs this type of surgery 3 to 4 times a month. I also saw some post op patients the times I visited Dr. Lee. You only need to make sure that you are healthy enough to undergo surgery and a normal ‘physical’ with a physician will let you know. As a matter of fact, Dr. Lee will send you paperwork which requires and EKG among other test and let’s you know whether you are prepared. Outside of that, you are in really good hands.

        You just need to determing whether if being on crutches for 3-4 months is feasible in your line of work. I only took a week off work before going back and I drove myself to and from work the entire time. I’m just happy that everything went as scheduled for me and that I had caring people to support me. This goes from Dr. Lee’s staff to my loved ones.

        I am quite happy to have explored this option. I can exercise, swim, and have the freedom I’ve always wanted.

        This is why I take the time to post on my experience in case it helps others. Good luck on whatever you decide and if there is anything I can answer for you, I will try to do so. :)

  26. hi
    Im 14 and i am laying in bed right know healing from my recent surgery on my fourth toe. I chose to get the cadevar bone graph because it seemed the safest but right now im to the point of fear.Im in my second week of recovery and i went to see my doctor today to get my stiches taken out but i ended up getting the pin or needle taken out also because of discoloracion.The tip of my toe was blue. My doctor also told me to cut down on my medication to only every 10 hours but my pain is so severe at moments to were i scream and cant handle it. He also recomended me to try and wiggle my toes. I can only wiggle the first three toes and not my fouth or fifth. Is it normal not to feel my fourth toe wen i thouch it and my toe is dark and grey? Wen i feel around the tip of my toe the skin just moves almost like my blood has been sucked out and theres nothing in there. Also my toe is still shorter then my fifth toe? Will the bone grow to the length its suppose to be? because the doctor has my wearing a mechanical device for three hours a day but now wants me to wear it for ten hours a day. I really dont know if the=is is all normal or am i going to lose my toe?

    • This sounds very alarming. Has your doctor considered taking you back to surgery and placing internal fixation or even an external fixator to keep the graft in place. Without that, the graft will likely become displaced.

      • No my doctor is not going to take me back to surgery because i already have metal pins or something like tht in my foor to hold it in place.

    • Allysa, I can not answer all of your questions due to the variables but I can try to help some. I had the one-stage done a few months ago. (my own one bone graph from my heel though) I went through numbness too in different areas of my foot (I had 4 incision areas cuz I had something else done at the same time). Some of it has gone away, but some of it is still present after 4 months. I feel that some of it will continue to go as time goes by, but it is possible that some will always stay with me. I will tell you that my fourth toe was numb after surgery and after the 3rd month the numbness went away in that toe.

      As far as the medication goes, I’m a real tough cookie but still found that medication was necessary. I was very mindful that I was taking narcotics and didn’t want it to be habit forming so I was careful and did my best to ween myself off if not needed. I’m inclined to say two things… 1. you’re doctor can’t feel your serious physical pain— take what you need! (only the recommended dose on the bottle of course) and 2. when your doctor tells you stuff ASK WHY. He may be telling you to do things because his knowledge and expertise are giving him those conclusions. Ask why. It will make you feel better to know why he thinks what he thinks. Maybe he said that because he doesn’t want it to be habit forming, (in case you can then make your own decisions cuz it’s your pain and your body), maybe he said that because the medication your taking has some side affects he’s seeing in your discoloration? (I’m just choosing something at random to make my point.) So ask why when he tells you anything. Ask it respectfully and I’m sure he’ll be obliging.

      You’re 14, I’m assuming you have a guardian with you. If so, talk things over with them. It will make you feel better. I was alone during my experience and it was very difficult to do it alone. Tell them your concerns so they can back you up when you discuss things at the doctors. ;o)

      I did not experience any discoloration in my toe other than the bruising colors after surgery that goes away in a few weeks time.

      My 4th toe also LOOKED shorter than I wanted it to be. The reason for that is too long to write right now.

      Lastly I have no idea about the mechanical device he’s having you wear. I’ve never heard of one with the one-stage method. (?)

      Keep your chin up. This surgery is not a quick fix. It takes 6 – 8 months to feel like you’ve healed. And even months after that, depending on the method used, there is still more healing to come.

      • Hi Luna,

        Who performed your surgery? Could you please elaborate as to why your toe isn’t as long as you expected? I have brachy on both of my feet. I have been told that both my metatarsal and toe bone are short so I would need 2 separate procudures. Not having them as long as would be normal is a major concern of mine.

        Also, weren’t you putting out a blog? I’m really interested in all of the information you’ve gathered with your research. Would you be willing to share your before/after photos? I can give you my personal email if you’d rather discuss off this comment board.

        Mita

      • Well Luna,
        That does remind me, he did say something about me not depending on the medication or so as you had said. so my guess is tht the numbness is normal and will go away through time?Thats what my mother had said but i just cant come to belive it. Perhaps my toe is bruised up then because i had a large needle about three inches long put into my toe to hold it down, but i could be wrong. I resently found out that the device that the doctor is having my put on is called an Orthofix i think and its a bown growth stimulator, it heals fractures and promote spinal fusion. it does it by electrical currents.Finally you mentioned how its not a quick fix?. and it takes about 6-8 months to feel like ive healed but my doctor told me that the healing will be done in about six more weeks and then i could go back to doing activities. So i just want to thank you for the information that you gave me.

  27. Hi Alyssa,

    That’s not supposed to happen and from my limited research, that is one of the major risks associated with the one-stage lengthening procedure. Who performed your surgery? If you contacted your doctor and he isn’t helping much, why don’t you seek a second opinion from another qualified foot surgeon? I’m really sorry you’re suffering so much pain. I’ll keep you in my prayers.

    Take care,
    Mita

    • Hey Mita,
      Can you just elaborate on thre major risks with the one-stage lengthening procedure?. I live in California and my doctor is Dr. Kernbach

  28. Alyssa/Mita,
    Many of your questions I’ve addressed in my Blog on blogger.
    I kept/keep an extensive Blog of my experience with many photographs addressing these issue. I did this for others who choose to get this surgery because I know there isn’t much info out there. At the moment my blog is set to private instead of public. By the Fall it will go public.

    My private settings in blogger allow me to add private viewers by adding their emails to the private viewing list. You can view it that way, but that’s up to you if you want to give your email address. I have about 25 readers right now and I don’t use their emails for any other purpose but for them to have access to the blog.

    The toe looking shorter is addressed in my post here: http://brachymetatarsia.blogspot.com/2011/03/9-days-after-surgery.html
    I won’t blame you if putting your email on here is just too public, but seriously how many people will read a Brachy page other than people who have it and are looking for info? LOL.

    My blog has support links and links to other blogs of people who have documented their experience as well. I have video of my first steps and many photos of how things looked week to week.

    I also have a post addressing the fact that doctor’s who say it’s a 6 week process are misleading patients: http://brachymetatarsia.blogspot.com/2011/05/dont-believe-it.html

    You can also choose to wait until it goes live in the fall if that helps, but all the info on there may be more use to you now? In any case, stay positive, it affects your healing. ;o)

    • Hi Luna,

      Could you please add me to the private viewing list of your blog? I’d really love to start reading more as soon as possible as I’m considering doing the surgery in the near future. My email address is mitavalle@gmail.com

      Thanks!

      • Mita, you’re all set. You should have an invite from Blogger in your inbox to my blog. Be sure to give me some feed back, send me a comment through the blog or whatever. I do hope the information is helpful to you. Thanks for being a follower of the blog! Appreciate it.

    • i would like to read more about this hear is my email Goatsrock2@gmail.com

      • Alyssa, you’re all set. You now have an invite to my blog from Blogger in your inbox. I know it will answer many of your questions. Be sure to give me some feedback through the blog by leaving comments to the posts you read, I’ll be sure to answer back! Thanks for following the Brachymetatarsia Blog! ;o)

    • Hi Luna.
      Im 28 yrs old and I am just finding out the name for whats wrong with my foot. I just figured it was a birth defect from my mother probably smoking while she was pregnant, she says she didn’t and that I was premature baby. When I was 9 yrs old I went to see a doctor here at Children’s Hospital in New Orleans. The doctor looked at foot like he was so confused and he had never seen anything like it. His recommendation was to wait because the toe would grow out as I got older. That was it and I left it alone. I have always wondered if it could be fixed. Now, I find all this out and I’m curious. So. I wanted to find out more about the whole experience you’ve had so, I was wondering if you could add me to your blog list. Thank you, Becca

      • becca, I am from the new orleans area and was wondering if u ever found a surgeon anywhere close to louisiana? `thanks

    • Hi Luna,

      I’m really thinking about doing this surgery but would love to ask you more questions. I’ve ready your blog extensively but would feel better if I could talk to you about my concerns. Would you be willing to call me or provide an email address where I could send you my questions?

      Thanks in advance for your time and consideration!

      Mita

    • Hi Luna,
      Can you add me to your blog, I would love to read it.
      My email: marshmellows100@gmail.com

    • Luna,

      I’d love to get your blogging site. I’ve lived with this all of my life!

      Thanks for sharing!

      Pam

    • hey can you add me so that i would be able to read your blog.. just had brachy surgery and it’s not going as expected.. lrubinov@aol.com
      Thank you
      Larissa

  29. Does anyone know of a dr. around the Louisiana area that preforms Brachymetatarsia surgery and the cost of the surgery?? plzz i really need help

    • Hi Shelly this is Becca. No I do not know of anyone in the New Orleans area bc after having that experience at Children’s Hospital here in New Orleans I never tried again to find another doctor. I tried to find out through this journal about other ppls experience but I haven’t gotten any responses. Sorry I could not be of any help. I am older now and its kind of point less bc my husband excepts me for my flaw. Eventhough I struggle with it still I take my husbands word for when he tells me I am beautiful just the way I am. I do hope u find a doctor around here though.

  30. i wanna know the cost of this surgery plzzzzzzzzzzzz

  31. I am 21 years old and I have this same problem on my left foot. I am waiting on my surgery to be set up and this article has made me not worry so much about so thank you for putting this information up.

  32. I am from Brazil and I also have brachymetatarsia. I have been searching about this anomaly but I haven’t find a doctor who does brachymetatarsia correction here in Brazil. I’ve been thinking about make my surgery in the US because my uncle lives in there. Do you know any doctor who does that surgery in Atlanta, GA? God bless you all.

    • I had my surgery in Atlanta, Ga 3 months ago and am getting my cast off tomorrow! My doctor was near St. Joseph’s hospital. I’d be happy to provide you with more info! -Adriana

      • Thank you so much Adriana. I’d love it. Can I send you an e-mail?

      • hi adrianna, i am very interested in how your surgery turned out. will u please post the results. God Bless You. I hope it went well.

      • I live in the Atlanta area and have suffered with this for years! Will you please email me your Dr’s information as well as anything else you may think would be helpful? Thanks! Pam

      • Hi Adiana, I know that i am reading your post several years later but i was curious as to who performed your surgery in the atlanta area. I too am from this area and looking for a trustworthy surgeon for this condition. Thank you so much!

    • check out Dr Stanley R Kalish, in GA,

  33. Hello everyone! I just want to share my experience in case it helps anyone out there. I am in my 20s and couldn’t believe there was a solution to my situation. Yes, like many of you I thought I was the only one.

    I had one stage surgey with Dr. David Lee in Phoenix, AZ last year. I am extremely happy with the results and not a day has gone by where I’m not happy or am grateful with the results.

    I live in Texas and not finding many local options, I opted to travel. I had a couple of doctors warn me that one stage surgery was out of the question and to simply get orthotics and live with my situation. When I contacted Dr. Lee, he was great about explaining the process along with the risks. Feeling comfortable with the information, I opted for the surgery. My need for surgery really went beyond aesthetics. I had ocassional pain in my foot and knee due to the imprper walking as a result of having a short toe.

    The surgery took over 4 hours. Arrowhead hospital was the best hospital I’ve even been in due to the high level of customer service and friendliness of all the staff.

    In my surgery, Dr. Lee used a bone graft from the ankle section. I had a short 4th metatarsal and needed about 2 cm to be even. He successfully accomplished that and I believe that is the limit when it comes to one stage surgery.

    The good thing is that since the bone is harvested from the ankle, it heals along with your foot. My understanding is that there are doctors that harvest bone from the hip and that causes people to have two areas to heal which creates more discomfort.

    After the surgery I had a pump for two days which provided pain relieving medicine directly to my foot. Pain was minimal considering the type of surgery I underwent. I was able to sleep as normal but of course was bed ridden.

    I was in crutches and unable to walk for about 4 months. After that, I was placed in a walking boot but had limited mobility. I was able to walk after 5 months in tennis shoes and eventually worked toward dressing shoes. I will say that while it is uncomfortable to be in crutches, time does go by fast. In my line of work, this was not a problem but I can see how this may not suit everyone. So consider your type of work and recovery time.

    Now, it’s important to know that while Dr. Lee took care of the surgery, I had a local podiatrist perform the follow up care. I would regularly mail him x-rays of my progress and even spoke to him a couple of times over the phone to get his opinion on the progress. My local doctor was one of the naysayer who had advised against the surgery. Boy was he surprised when he saw the impossible happen. In the end all was well.

    Aside the surgery, one thing that I want everyone to know is that Dr. Lee is very attentive. I’ve come across very few doctors that show concern and take the time to understand a particular situation. He and his staff are really patient and simply nice. The office visits were very well scheduled and I spent minimal time in the waiting area. Yes, that is surprising when compared to most doctor visits.

    If you can save the money and travel to Arizona for this surgery, then I highly suggest you do so. I arrived on a Thursday for an actual consultation with Dr. Lee where he took x-rays and once again covered the procedure and risks. Some consent forms were signed and he prescribed medication to be take post surgery. I had my surgery on a Saturday and was allowed to fly back home the following Thursday. So I was only away from home for 7 days. My insurance also covered the most of the cost.

    The scaring is minimal and I much rather have a slight scar, which no one questions, than not being able to be barefoot at a pool or beach. If you have any questions, please post and I will try to answer.

    • Hi Jo Jo.
      Nowadays can you walk normally or feel some uncomfortable?
      Can you tell me about the risks of Dr. Lee’s surgery?
      Thanks for sharing your experience. :)

      • I can walk more comfortably than before since I no longer have the pain. I wear all the shoes I used to wear before the surgery such as tennis shoes and dress shoes.

        I do however get a slight swelling on days where I am super mobile. This swelling is something that Dr. Lee informed me about and it’s suppose to occur for at least a year. There is no pain whatsoever. The swelling is minimal and goes away by the next day on its own. An ice pack also helps out.

        As far as the risks go, both surgeries have risks, here is what I recall for the one stage surgery:
        1 – Since the bone, muscle, and veins are being extended on such a quick notice, there could be a possibility that blood flow could be stopped and cause the loss of the toe after the surgery. Think about a water hose that is strectched out beyond its usual limit. The water has trouble traveling since the stretching causes it to become thinner.

        Dr. Lee did mention that this has not happened to him but it is important to know as I consider a decision.

        2 – There is the possibility that the bone graft could not heal as expected and require a second surgery. He mentioned that this risk is higher on older people since it basically deals with the body’s ability to heal bone. The reality is that as we get older, we don’t heal as fast or the same. If you think about it, this would not be tied to his ability as a doctor but rather how well our body heals.

        3 – During the recovery process (the first 4 months) you have to be extremely careful with your foot. If you were to fall or bump it, it could potentially dislocate the graft. This can lead to either requiring surgery or risking movement of the bone. This is important to know because it allows you to prepare properly in case you will need assistance in the home or your job.

        On the other hand, this surgery offers other better benefits:

        1 – There is less risk of infection than those patients that use the external fixator.
        An external fixator is an actual piece of metal that is joined at opposite ends of the metatarsal that needs to be corrected. The bone is broken during surgery and you have to turn the fixator a prescribed amount each day to eventually give your metatarsal the right length. So during that process, which takes several weeks, you actually have an enormous piece of metal to move around which seems to be a higher risk of dislocating the bone. In most cases you still have to be in crutches.

        2 – There is still the risk of the bone not healing fast enough or healing correctly.

        3 – There is a higher risk of scarring due to the installation of the fixator.

        4 – Some consider this process more complex and, as myself, opt for the one stage surgery. The surgery takes a couple of hours and less obstrusive.

        If you email Dr. Lee he will email you a PDF packet which details the process. It will answer many of the questions you may have.

        I started by requesting the packet and following its intructions which included taking x rays with a local podiatrist and sending them to Dr. Lee. He was able to set up a phone conference and let me know the available solutions. I was fortunate to qualify for one stage.

        One tip to for anyone that is considering doing the surgery is to get a shower chair or bench as it will make showering much easier. My hotel forunately had one and I was able to order one in time to have it delivered when I arrived home.

        If you have any other questions, I’ll try to help.

    • Hi, Jojo
      Thanks so much for your info :) I am still contemplating the surgery because I don’t know if I should do the external fixator or one stage lengthening. I know that I have the 2cm to go but I’m so nervous to think that I will have a normal looking foot…. I have read all the info out there and I know that both ways are complicated, I’m just glad its only one foot that I have brachy on and grateful for all the help everyones giving me. I had bunion surgery done with Dr. Lee and in recoup right now I can at least walk on it sometimes but I know the brachy surgery I won’t be able to step on it at all.so I’m just waiting til next year. Do you have pics of your surgery outcome? Or a blog?
      Thanks so much

  34. Hello, My name is Fletcher.

    I had surgery today lengthening the first metatarsal of my right foot. The pins and external fixator were applied today, I am returning to the hospital in 10 days to being the lengthening.

    How should I deal with the risk of bumping the rods while I am sleeping? What would the consequence be if I did bump the rods?
    I am not worried about the time when I am awake but mostly when I am asleep.

    Advice would be much appreciated.

    Thank You.

  35. Hi Fletcher,
    I understand your worry about bumping your foot because I had the same worry when I had my external fixator device. I recommend keeping your foot elevated on a pillow and over your blankets. I actually bumped my foot many times while wearing the device but the xrays showed no damage at all. Don’t worry too much about it because the device was made so that it stays in place even if u do bump your foot. Best of luck!

  36. Hello everyone,

    I like many of you or your family members have Brachy. Today is the first time I knew what the condition was called, and that there was a surgery for it. I am engaged to a man that I have been with since I was 14 in High school. We will be married in two years. He is not bothered by my feet never has been and never will be. He even named my toes Stubby and Stubbilicious(one on each foot). It does suck that my feet are a little different then anyone elses but they have been this way for a while now maybe close to ten years, I am 23. Learning of the surgery was nice but I doubt that I will have it performed on me, and I am even wearing Flip Flops to my wedding.

    Unless something happens and it becomes dangerous to have my feet the way they are i will embrase what I have and continue to live my life ( which has been normal, no loss of friends or anything like that, I even danced for 10 years including pointe).

    ~Desiree

  37. I’m really happy for you! I hope one day I can embrace my brachy and find someone who will love me with it too. Thank you for your encouragement and congrats on your upcoming wedding!

  38. I’m really happy for you! I hope one day I can embrace my brachy and find someone who will love me with it too. Thank you for your encouragement

  39. Hi Luna!
    I’m thinking of doing the surgery but I’ve got lots of question
    Can you add me to your blog, I would love to read it.
    denise_rose_diola@yahoo.com

  40. Hi Luna!
    I would love to see your blog. I am 6 wks post op and mine was done by taking a bone from my heel. I have brachy on my 4th toe right foot. I am 45 and live in the UK. I’d like to know what exercises I need to do to help me gain control of my toe.
    Thanks.
    seaweed5254@yahoo.com

  41. Hi Luna please add me ciscosillo@yahoo.com Thanks so much!

  42. Hi. can you add me too please? juanipazos@yahoo.com.ar thks!!

  43. Hi everyone am Taddy 18 yrs old …does anyone know a doctor I could contact in New york ?
    This is my email address only-girl42@hotmail.com

  44. It’s now LIVE. Be sure to follow it: http://brachymetatarsia.blogspot.com/
    You can reach me via commenting on my blog. Be well.

  45. Jo Jo-
    Hi! My name is Chris and I live in Austin, TX, and am seriously considering this surgery, and traveling to Arizona if I qualify for the one stage surgery with Dr. Lee. Could we connect via email so I can ask you some questions? Most of
    these posts are several months old and I’m hoping you get this message, not sure exactly how this works. Thanks so much!

      • Chris have u gone to see Dr.al kline? He’s the one that wrote this article.you said u live in austin.I live in south Texas.he is located in corpus christi.I emailed him a couple of months ago and I want to make an appointment for next month because I’m really considering this surgery as well.

      • Hi Letty-
        I have decided to do the external fixator, I just had my appointment today to get everything arranged. I am using a local podiatrist that seems to be really good, and he has done about a dozen of these surgeries over the last several years. Not a large number, but he just finished one last month and the outcomes have all been good. I’m considering doing a blog as well, since so many of us are struggling trying to figure out what to do, and what the whole process is like. It won’t be like Luna’s, but I’ll do my best to be informative. Once I get it going, I’ll post the info here. If I were further south in Texas I would certainly consider Dr. Kline. Good luck!

  46. Two new videos on Brachymetatarsia:

    Brachymetatarsia – A Transformational Journey

    Brachymetatarsia Surgery

  47. Hi There,

    I have the same problem and on both feet as well. I am from South Africa. A lovely family friend introduced me to thee most (LIFE CHANGING… Hehe) doctor. I visiteed the doctor who gave me the exact information above. I then decided to have the surgery done. He does not advise his patients to go for the external method as it is very risky. I was in surgery for about 2 hours and when i came out i didnt feel that much of pain. I am now in the 3rd week of my recovery and it feels great. I have to be off my feet for 8 weeks , but 8 weeks recovery is worthwhile for a lifetime of happiness. I would advise those of you out there to def go for surery!!!

    Its worth it :)

    • Wow u r giving me hope. I have the problem on ma left feet am so not comfortable on showing my feet , I don’t wear open shoes I hide my left feet most of d times I was born like this my mom is having d same problem both her feet. Am in south africa where can I get help?

  48. Hi all-
    I just had the surgery two days ago using the external fixator. I started a blog at Brachynomore.wordpress.com

    I hope this will be helpful to those considering surgery. Best of luck to you all!
    Chris

  49. Hi all-
    I just had the external fixator surgery done two days ago. I started a blog at Brachynomore.wordpress.com

    I hope if you follow it that it helps those of you considering surgery. Best of luck to you all!
    Chris

  50. Hello,

    I’m in Atlanta, GA and 26 years old. I have Brachymetatarsia in both feet. If anyone can help me find a good surgeon please help!!! I want this done so badly. If you know the cost and location email me: reneemoore2012@yahoo.com.

  51. Hi Everyone!
    I had surgery 2weeks ago and all is going pretty well so far. I started a blog at Brachynomore.wordpress.com.
    Follow me if you are interested, I’d love to help anyone considering surgery. Take care!
    Chris

  52. My blog on brachymetatarsia is up and running. If you are interested, the address is Brachynomore.wordpress.com
    I hope this is helpful.
    Chris

  53. Achybrachyheart

    Hi I’m 40 years old and has hid and been teased about this all my life and have re cently decided to have the one stage lengthening with a cadaver bone on May 25, 2012. I’m doing a blog and will post it soon. Thank you all for sharing!

  54. Katrine L. Sagstuen

    I have done the exact same thing as her, on the same foot and the same bone. I´m so glad i did it :`)

  55. Hi everyone. I am 23 years old and had the one stage surgery done this past April. Currently I am in my 13th week of recovery and am walking in a comfortable tennis shoe with no pain. I was in a cast for a total of 11 weeks. I am 100% happy that I had this surgery done because it is completely life changing. I have brachy on both my feet and chose to have the left foot done first. Eventually I will more than likely get the right foot done as well but not anytime soon. I hope this helps anyone considering the surgery it really is worth it!!

  56. i am 14 and i hav brachy on ly left foot. i am always concious about my toe showing up in sandals but i still wear them cuz they r pretty :p but with the fear of someone noticing my freaky toe and commenting on it. i am afraid no boy would like me for this. i am very scared of surgeries and i dont want to get one. my mom said its a minor thing but after readin everyones comment about getting surgeries and being so happy with it, i feel like i should do the surgery but i am so scared!!! :'(

  57. Hi I’m a 28 year old female from South Africa, I have suffered with this condition throughout my life I am desprately trying to correct my shortened fourth toe, my medical won’t pay as it is considered as cosmetic surgery. Please if you know of surgeons in my country that could help me without me breaking the bank I would be very greatful.

  58. Hi every one! You can follow my blog in braquimetatarsiainjerto.wordpress.com.
    It is in spanish but you can try to translate all with google or something like that.
    See you!

  59. Hello! I’m 24 and I also have this condition, on both feet. Does anyone know of an experienced center/doctor in EUROPE that performs these elongation surgeries using a mini external fixator? Thank you. Sandra

  60. Hello Dr.Kline its been about 5 years since i have had this surgery and I really thank you for it. Now I love to were sandals, and I have a lot more confidence in myself.

  61. hi! I’m 24 and just learned about this condition. I seriously thought I was the only one with this problem and I honestly feel it’s holding me back from experiencing a lot in life. But I have a question…how do I go about getting this done????? Can some one please help me

  62. I have brachymetatasia I want to know which orthopaedic surgeon in south africa can help me

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