Novel Techniques for Acute Lengthening of Metatarsal for Treatment of Brachymetatarsia with 2cm and More Shortening

CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: Previous acute lengthening of metatarsal for the treatment of brachymetatarsia has been limited to 1cm. The success of acute lengthening has not been as predictable. I have successfully been able to acutely lengthen up to 2.2 cm with the use of allograft. I have successfully done this in 10 patients for the last 2 years. METHODS: The method involves acute lengthening and transfer of the extensor longus and Brevis. A complete release of the MPJ which involves the entire capsule as well as the lumbricles and interosseus medial and lateral. Also I have created a 'joint spacer ' by using a fiber tape (Arthrex) which is made in to a donut shape and placed in the joint and held in placed with a k wire that is passed through the digit then through the spacer and further advanced to the metatarsal. This k wire is removed 6 weeks post op. I also use a temporary external fixator to distract the metatarsal segments after doing an Osteotomy at the base or the metatarsal. Once the appropriate length is achieved the allograft is cut to size and placed and secured with screws and an 8 hole plate. Then the temporary ex fix is removed. Tendons sutured and secured. Skin is closed. The only hardware that is exposed is the .062 k wire. 6 weeks post op. The k wire is removed and a Stab incision is made at the level of the MPJ and the spacer is removed. This will keep the joint space maintained which make the digit be able to move after such a large acute lengthening. Part of the Peotocol is to have the foot in good compression by using a 3M 2 layer compression system. Which keeps the incision from opening. RESULTS: For the past 2 years I have performed 10 acute metatarsal lengthening successfully with minimal complications. This method is reproducible by any foot and ankle surgeon CONCLUSION: Using this step by step technique has resulted in a predictable and successful outcome. Previously the lengthening of a short metatarsal has been limited to 1cm and below if you wanted to outcome to be good and without major complications such as MPJ subluxation and digital deformity and most importantly not being able to lengthen the metatarsal to its appropriate length. This novel technique can be done in any ambulatory surgical setting. It also uses allograft which makes its less painful for the patient and decreases the complication rate when compared to using autograft