Dr. Joel Aronowitz - REAL PATIENTS REAL STORIES: Brachymetatarsia AKA Shortened Metatarsals in the Foot on X-Ray
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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz: “So Jen has an interesting problem on her cute little feet, and she's really sweet to let us show you what it is. So, Jen, tell us what's going on with your feet and why those, these two toes look funny and why this toe looks funny. So basically, my toes are elevated. There's an empty space where my toe should actually be, and my shoe just rubs on the top, and I have a bunch of calluses on the bottom. And did you have an injury, or were you born that way?”
Jen: “So I noticed it because I have pictures of the baby, and they're like normal feet, and then 10th grade, no sorry, when I was in 10th, so 5th grade is when it started to, so I call them my 5th grade toes. So what's happened is there's shortening of the metatarsal, and the toe itself has pulled back as a result.”
Dr. Joel Aronowitz: “So this toe is a normal toe; it just belongs out about a centimeter, centimeter and a half more. And that's because she's lost length of that metatarsal, and we'll see that on the x-ray in a second. So these toes are getting crowded by the other toes because there's tension bringing the metatarsal phalangeal joints together. So why don't you put your foot, just rest it and put this just a little bit further back. Okay, so here's the metatarsal, the normal metatarsal. Here's a normal metatarsal, and you can see the joint, and there's a space between the two bones because the cartilage that's in contact is not showing up on the x-ray. So it looks like a space, but that space is actually taken up by a cartilage pad there, the articular cartilage. And on this toe, you can see this metatarsal has partially resorbed. And so here is the base of the phalanx of her toe, just like here. But a lot of this metatarsal has resorbed, and there's not even a normal joint space there. So we're going to, let's take a look at the other foot also.”
Jen: “So I broke, I think I broke this one like in April. It was super purple.”
Dr. Joel Aronowitz: “Okay, and we can see there's not a normal amount of bone in the toes. And the same thing with this shortening of the metatarsal. Here's the metatarsal shaft. You can see so much less bone in the head, less mineral in the bone. And here is a normal metatarsal, and it is, it's more dense and it's longer and has a normal head. And here we don't, it's resorbed. Here's her great toe, and you can see the angulation, probably from your shoes. And these little round things are the sesamoid bones that are in the tendon that's normal. And it's like very similar to the patella of our knee. So we're going to send you to one of our great podiatrists on staff at Tower. And then we'll do another episode explaining how we can manage this”.
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