Combined One-Stage Shortening and Lengthening for Multiple-Ray Congenital Brachymetatarsia: A Surgical Technique Report

The surgical management of congenital brachymetatarsia is based mainly on 2 types of lengthening surgeries for shortening correction: either a gradual lengthening using distraction osteogenesis or a one-stage lengthening with bone graft. We report a detailed surgical plan and surgical steps of the combined one-stage shortening and lengthening. The aim is to restore a homogenous metatarsal parabola. The used guide for the optimal metatarsal parabola was the perpendicularity of the angle between the long axis of the corrected second metatarsal and the line joining the center of the lateral hallucal sesamoid to the center of the head of the corrected fourth metatarsal. Following a careful calculation of the aimed final lengths of each metatarsal, a cylindrical graft of specific length was harvested from the long metatarsals and lodged in the short neighboring ones. All osteotomies were fixed with K-wires. Besides one nonunion out of 28 osteotomies, the radiologic and clinical results were excellent. This technique is simple, low-cost, easily reproducible and highly appreciated by the patients. Levels of Evidence: Level V—expert opinion.