We retrospectively reviewed outcomes, complications and their influencing factors after distraction osteogenesis for fourth brachymetatarsia.

We performed twenty-two cases of metatarsal lengthening with external fixator in sixteen patients for fourth brachymetatarsia from May 1998 to May 2000. At the final follow-up, AOFAS scores were awarded according to stiffness, pain, function, alignment and the satisfaction of patients.

On average, the gain in length was 16.5 mm, the percentage of lengthening 38.9%, and the healing index 72.9 days/cm. There were some complications including subluxation of the metatarsophalangeal joint in 7 cases, stiffness in 5 cases, pin tract infection in 2 cases, and angular deformity in 3 cases. Those having a percentage of lengthening of less than 40% and those involving only the metatarsus had better results. Most patients were satisfied with the corrected result, though one unsatisfied patient underwent revision surgery.

Even though distraction osteogenesis for fourth brachymetatarsia is effective, excessive lengthening in patients involving both metatarsus and phalange can produce minor complications.