|IMAGES IN RHEUMATOLOGY
|Year : 2016 | Volume
| Issue : 4 | Page : 228-229
Unusual cause of foot pain
Venkatraman Indiran, Prabakaran Maduraimuthu
Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India
|Date of Web Publication||8-Nov-2016|
Dr. Venkatraman Indiran
Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, 7 Works Road, Chromepet, Chennai - 600 044, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Keywords: Brachymetatarsia, foot, pain, short metatarsal
|How to cite this article:|
Indiran V, Maduraimuthu P. Unusual cause of foot pain. Indian J Rheumatol 2016;11:228-9
A 33-year-old male presented with pain in both feet for the last 3 months. There was no fever, stiffness, or swelling. On examination, there was no warmth or tenderness. Fourth and fifth toes on both sides were short, with the left side being shorter. Plain radiograph of both feet was obtained [Figure 1]. His blood investigations including rheumatological profile were unremarkable. On the plain radiograph, the fourth and fifth metatarsals appeared short on both sides, with the left side being shorter [Figure 2]. There was no erosion/bony destruction. Later, the patient revealed that his father as well as grandfather had similar short toes. He has been advised footwear modification and review after 6 weeks.
|Figure 2: Plain radiograph (anteroposterior projection) showing bilateral short fourth metatarsal|
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Brachymetatarsia is an uncommon condition in which one of the metatarsals is abnormally short. This usually involves the fourth toe and is often bilateral. If it affects more than one toe, the condition is called brachymetapody. Short first metatarsal, a less common form of brachymetatarsia, is known as Morton's foot. Incidence of brachymetatarsia ranges from 0.02 to 0.05% and is about 25 times more common in females than males.
Most of the cases are congenital, hereditary, and idiopathic but can also be associated with endocrinopathies such as pseudohypoparathyroidism and syndromes such as Down's and Turner's syndrome. Shortened metatarsal occurs due to the premature closure of the metatarsal epiphyseal growth plate. Patients may present due to cosmetic defect, metatarsalgia, callosities over the second and third metatarsal heads or clawing of the toe. Nonoperative treatment includes shoe modifications that usually improve symptoms. Surgical treatment improves function as well as appearance. Lengthening may be achieved either by distraction osteogenesis or by involving osteotomy, bone grafting, and soft tissue correction., Although this condition has significant gender difference, to the extent of being considered an exclusively female disease, this case emphasizes the prevalence of hereditary brachymetatarsia in males in a single family.
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[Figure 1], [Figure 2]