A Modified Deformity Correction Method for Congenital Brachymetatarsia of Bilateral Fourth Toe Using an External...

Brachymetatarsia is a rare congenital deformity characterized by a shortened metatarsal, frequently affecting the fourth ray. It can result in cosmetic concerns, pain, and functional discomfort. While distraction osteogenesis has been widely used, complications, such as joint subluxation remain a concern.

A 21-year-old female presented with bilateral congenital brachymetatarsia of the fourth metatarsal, associated with pain and deformity. She underwent gradual lengthening using external rail fixators combined with axial trans-articular K-wire stabilization of the metatarsophalangeal (MTP) joints to prevent subluxation during distraction.

The procedure resulted in satisfactory lengthening (2 cm/metatarsal), restoration of the metatarsal parabola, and full functional recovery of the MTP joints (MTPJ) without subluxation or major complications. Clinical and radiological outcomes were excellent at 6 months post-operatively.

The modified technique combining external rail fixators and trans-articular K-wire stabilization effectively corrected bilateral fourth metatarsal brachymetatarsia. It provided enhanced joint stability during distraction and minimized complications, such as MTPJ subluxation. This approach may be preferred in cases requiring gradual lengthening with structural joint protection.