Brachymetatarsia is a relatively rare congenital bone growth disorder affecting one of the metatarsal bones, most commonly the fourth metatarsal. It is characterized by premature cessation of length growth in the affected bone. Approximately 1 in 3000 people are affected, with girls being about 26 times more likely to have this condition than boys.

The visible consequence is that the affected toe appears shorter than the others, even though it usually has a normal length. Besides the aesthetically distressing appearance, which many affected individuals find particularly challenging, there can also be complaints in the forefoot due to altered weight distribution.

Various surgical methods are available, depending on anatomical conditions and patient preferences:

• One-stage lengthening of the bone in a single step using a small graft (autologous or allogeneic bone from a bone bank).
• Stepwise lengthening with a distractor (internal or external fixator) over a few weeks, followed by another procedure to remove the distractor after bone healing.

This method of one-stage lengthening has been refined at ARS PEDIS to the extent that, in some cases, lengthenings of up to 2 cm are possible, with postoperative treatment in a walking boot without crutches.