290 Forefoot Reconstruction
Fig. 38a. Congenital brachi metatarsal 1.
1, 2, 3. This deformity may be painful on the corresponding short ray (dorsal flexion of the toe, painful MTP joint) or mostly on the adjacent rays: In this example metatarsalgia on the third ray. Since our cases are not adults, we do not lengthen the short metatarsal. On the contrary it is easy and harmless to shorten the other metatarsals.
4. Our aim is to reestablish as far as possible the metatarsal parabola.
5, 6. One example of brachi metatarsal on the second ray: We shorten the four other metatarsals: Excellent result.
7, 8. Brachi metatarsal on the fourth ray and the treatment.
9. Shortening of three rays.
Lesser Metatarsal Aplasia (Congenital Brachi
Metatarsal)
We only have experience of this deformity for adult patients. This deformity may be painful not only on the corresponding short ray but also on adjacent metatarsals that have a relative
excessive length. In adults, lengthening of the brachi metatarsal is not a good solution. We prefer to shorten the other rays not quite as far as the short metatarsal, but trying to get a com- promise which respects the rules of a correct metatarsal relative length and metatarsal para- bola. This technique will relieve pain, preserve the cosmetic appearance and take into account the length of the contra-lateral foot for foot- wear.
