Distraction lengthening for the congenitally short metatarsal: a case report

Distraction lengthening has gained wide acceptance in general orthopedics and in upper extremity reconstructions. The application of this technique to the foot is presented. The congenitally short fourth metatarsal of a 16-yr-old girl was successfully lengthened by a two-stage procedure. At the first stage, an open diaphyseal osteotomy was performed and the distraction apparatus was secured. Over the ensuing 5 weeks, 36 mm of distraction was achieved. At the second stage, the distracted gap was filled with a fibular bone graft. Following uncomplicated healing, there was no gait, intrinsic muscle, or tendon abnormalities. Metatarsal distraction lengthening can be safely accomplished provided there is good bone stock, adequate soft tissue, and a cooperative patient.