Brachymetatarsia of the Fourth Metatarsal, Lengthening Scarf Osteotomy with Bone Graft
A 16-year-old female was referred with unilateral shortening of the left 4th toe. The toe was not painful, however caused psychological distress when wearing opened toed footwear and whilst barefoot at swimming pools. Examination revealed a left 4th toe that was clearly short and sitting dorsally. Radiographs () showed a 4th metatarsal which was approximately 7 mm shorter that the 5th metatarsal with a dysplastic metatarsal head. The etiology of her deformity was unknown.\nA single stage lengthening metatarsal scarf osteotomy was performed. The rationale for a single procedure was to limit disruption from schooling. The 4th metatarsal was approached through a laterally based Z-plasty incision. A wide capsular release was performed and the metatarsal was elevated up and a lengthening scarf osteotomy performed. Two 1cm allograft cancellous cubes (RTI Biologics, United States) were used and the osteotomy held with one Omnitech® screw (Biotech International, France) (). Z lengthening of the short and long extensor tendons was performed.\nPost operatively, the patient remained heelweight bearing for 6 weeks. The patient had routine post-operative follow up () and the additional length of 9 mm (2 mm longer than 5th metatarsal) had been maintained, however, there was some scar contracture keeping the toe dorsally elevated by ten degrees. The patient remained satisfied with her overall increase in length of the 4th toe and was discharged at one year.