Clinical Orthopaedics and Related Research®

, Volume 468, Issue 7, pp 1933–1942 | Cite as

One-stage Metatarsal Lengthening by Allograft Interposition: A Novel Approach for Congenital Brachymetatarsia

  • Sandro Giannini
  • Cesare Faldini
  • Stavroula Pagkrati
  • Maria Teresa Miscione
  • Deianira Luciani
Surgical Technique



Congenital brachymetatarsia, a shortened metatarsal bone, can be corrected surgically by callus distraction or one-stage lengthening using bone graft.


We asked whether one-stage metatarsal lengthening using metatarsal homologous bone graft could improve forefoot function, lead to metatarsal healing, restore metatarsal parabola, and improve cosmetic appearance.

Patients and Methods

We retrospectively reviewed 29 patients (41 feet) in whom we lengthened 50 metatarsals. Surgery consisted of a transverse proximal osteotomy of the metatarsal shaft and interposition of a metatarsal homologous bone graft (average, 13 mm long) fixed with an intramedullary Kirschner wire. Minimum followup was 3 years (mean, 5 years; range, 3–11 years).


Bone union was achieved in all cases. The mean preoperative American Orthopaedic Foot and Ankle Society score was 37 points (range, 28–53 points) and the mean postoperative score was 88 points (range, 74–96 points), with an average improvement of 51 points. Radiographically, the mean gain in length was 13 mm (range, 10–15 mm), and the mean percentage increase was 23%.


One-stage metatarsal lengthening using interposition of metatarsal homologous bone graft to correct congenital brachymetatarsia has low morbidity for the patient, limited complications, short recovery times, and restores forefoot anatomy.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


Kirschner Wire Metatarsal Head Metatarsophalangeal Joint Metatarsal Osteotomy Callus Distraction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Graham Baxendale for revising the manuscript.


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Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Sandro Giannini
    • 1
  • Cesare Faldini
    • 1
  • Stavroula Pagkrati
    • 1
  • Maria Teresa Miscione
    • 1
  • Deianira Luciani
    • 1
  1. 1.Department of Orthopaedic and Trauma SurgeryUniversity of Bologna, Istituto Ortopedico RizzoliBolognaItaly

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