summary Brachymetatarsia is a rare congenital condition caused by premature epiphyseal closure of the metatarsals that presents with shortening of one or more metatarsals. Diagnosis is made clinically with hypoplasia and shortening of most commonly the 4th metatarsal. Treatment is observation with shoe modifications for mild cases. Surgical metatarsal lengthening may be indicated in patients with persistent pain with shoe wearing. Epidemiology Demographics female:male 25:1 Anatomic location shortening of the fourth metatarsal is the most common often bilateral Etiology Pathophysiology cellular biology due to premature epiphyseal closure of the metatarsals Associated conditions Down’s Syndrome Turner’s Syndrome Larsen’s Syndrome Albright’s Syndrome Diastrophic Dwarfism Presentation Symptoms discomfort with shoe wearing Imaging Radiographs recommended views AP and lateral weight-bearing views findings shortening of the affected metatarsals discontinued metatarsal parabola Treatment Nonoperative shoe modifications indications first line of treatment and will generally will improve symptoms technique extra-depth or extra-wide shoes taping and manipulative reduction attempts are ineffective Operative metatarsal lengthening indications if symptoms persist in the older child amputation very rarely indicated if symptoms persist in the older child extensor tenotomy and capsulotomy indications none: not likely to sufficiently correct the deformity fusion indications result in complications and generally are not indicated.