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Year : 2016  |  Volume : 11  |  Issue : 4  |  Page : 228-229

Unusual cause of foot pain

Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai, Tamil Nadu, India

Date of Web Publication8-Nov-2016

Correspondence Address:
Dr. Venkatraman Indiran
Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, 7 Works Road, Chromepet, Chennai - 600 044, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-3698.193589

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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

How to cite this URL:
Indiran V, Maduraimuthu P. Unusual cause of foot pain. Indian J Rheumatol [serial online] 2016 [cited 2021 Apr 14];11:228-9. Available from:

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 1: Clinical photograph showing bilateral short fourth toes

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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.[1] 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.[2]

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.[3] 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.[4] 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.[4],[5] 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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  References Top

Schimizzi A, Brage M. Brachymetatarsia. Foot Ankle Clin 2004;9:555-70.  Back to cited text no. 1
Giannini S, Faldini C, Pagkrati S, Miscione MT, Luciani D. One-stage metatarsal lengthening by allograft interposition: A novel approach for congenital brachymetatarsia. Clin Orthop Relat Res 2010;468:1933-42.  Back to cited text no. 2
Formosa N, Buttigieg M, Torpiano J. Congenital brachymetatarsia and Turner syndrome. Arch Dis Child 2016;101:332.  Back to cited text no. 3
Desai A, Lidder S, R Armitage A, S Rajaratnam S, D Skyrme A. Brachymetatarsia of the fourth metatarsal, lengthening scarf osteotomy with bone graft. Orthop Rev (Pavia) 2013;5:e21.  Back to cited text no. 4
Jones MD, Pinegar DM, Rincker SA. Callus distraction versus single-stage lengthening with bone graft for treatment of brachymetatarsia: A systematic review. J Foot Ankle Surg 2015;54:927-31.  Back to cited text no. 5


  [Figure 1], [Figure 2]


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