ABSTRACT
In children congenital causes of length discrepancy in metatarsals are more likely than acquired causes. These are two common scenarios: the adolescent female who has a short fourth metatarsal troubled by the appearance and reluctant to wear open footwear or the young child with a short first metatarsal who presents as transfer metatarsalgia. Length discrepancy of the rays can be encountered in macrodactyly. Brachymetatarsia and macrodactyly are considered separately as the approach to treatment differs. Many children with a length discrepancy of the metatarsals are asymptomatic. Problems arise in adolescence when perceptions of body image take precedence. In severe brachymetatarsia, shortening neighbouring rays can restore partially normal length relationships of the metatarsals, leaving the difference to lengthening the short ray. This combined approach is important in cases with a >50 percent length discrepancy; addressing this magnitude of discrepancy purely by gradual lengthening techniques has a high risk of complications.
