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Brachymetatarsia

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Topic updated on 11/11/14 7:35pm
Introduction
  • A congenital hypoplasia of one or more metatarsals
  • Epidemiology
    • location
      • shortening of the fourth metatarsal is the most common
      • often bilateral
    • demographics
      • female:male 25:1
  • Pathophysiology
    • cellular biology
      • due to premature epiphyseal closure of the metatarsals
  • Associated conditions
    • Down’s Syndrome 
    • Turner’s Syndrome 
    • Larsen’s Syndrome 
    • Albright’s Syndrome
    • Diastrophic Dwarfism
Presentation
  • Symptoms
    • discomfort with shoe wearing
Imaging
  • Radiographs
    • recommended views
      • AP and lateral weight-bearing views
    • findings
      • shortening of the affected metatarsals
      • discontinued metatarsal parabola
Treatment
  • Nonoperative
    • shoe modifications
      • indications
        • first line of treatment and will generally will improve symptoms
      • technique
        • extra-depth or extra-wide shoes
        • taping and manipulative reduction attempts are ineffective
  • Operative
    • metatarsal lengthening
      • indications
        • if symptoms persist in the older child
    • amputation
      • indications
        • if symptoms persist in the older child
    • extensor tenotomy and capsulotomy
      • indications
        • none: not likely to sufficiently correct the deformity
    • fusion
      • indications
        • result in complications and generally are not indicated. 

 

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