Bilateral Staged Distraction Osteogenesis of the Fourth Metatarsal With Biplanar First Metatarsal Osteotomies in an Adolescent Athletic Patient: A Case Report

IntroductionCongenital fourth-ray brachymetatarsia and juvenile hallux valgus are rare forefoot deformities that, when coexisting, may amplify biomechanical dysfunction, pain, and footwear intolerance, particularly in adolescent athletic patients. No reports describe a combined surgical approach to correct both conditions in adolescents.MethodsA 15-year-old female with bilateral symptomatic juvenile hallux valgus and congenital fourth-ray brachymetatarsia was treated with staged unilateral biplanar first metatarsal chevron osteotomies and fourth metatarsal distraction osteogenesis with the use of an external fixator. Distraction was performed at approximately 0.5 mm per day to a planned length of approximately 13.5 mm, followed by consolidation and device removal. The contralateral side was treated after functional recovery of the first foot.ResultsBoth feet achieved successful correction of hallux valgus and restoration of fourth-ray length with radiographic confirmation. The patient had maintained alignment, resolution of forefoot pain, tolerance of standard footwear, and return to baseline athletic activity without complications or recurrence. Conclusion.ConclusionThis case demonstrates that staged biplanar first metatarsal osteotomy combined with fourth metatarsal distraction osteogenesis can safely and effectively restore forefoot alignment and function in adolescents with coexisting hallux valgus and brachymetatarsia. This combined strategy offers a viable treatment pathway for complex bilateral forefoot deformities in young active patients.