Material: This work presents the treatment of 114 patients (125 feet), aged 9 – 53 years for:

- 82 short feet due to congenital metatarsal hypoplasia,

- 3 first toe stumps (P1),

- 32 post-trauma and post-surgery cases including two after resection of the metatarsal heads.

The cosmetic defect was the principal complaint in most patients (95 women), as well as complications related to wearing shoes. Pain in the forefoot resulted from biomechanical conflicts between the toes and the metatarals.

Methods: An oblique or transverse osteotomy for lengthening was performed on the base of the metatarsals and the phalanges. An external fixator, with modifications, was used. Pins were driven through the joints during the osteosynthesis to prevent dislocations. Traction was started three to five days after surgery at the rate of 0.5–1 mm/24 hr. Partial weight bearing on the operated limb was recommended. The external fixator was dismounted progressively with ablation of the pins allowing complete rehabilitation of the toes and walking exercises. These measured favour formation of regenerated bone and remodelling into hard bone, shortening treatment which was 45 ± 6 days in the study group.

Results: Outcome was followed for 1 – 3.5 years. The desired lengthening of the forefoot (1.5 – 5 cm was achieved in all feet. All feet were pain free and the cosmetic result and foot bearing on the floor was improved. The patients were satisfied, with no complaints, and walked with full weight bearing without complementary prostheses and wearing ordinary shoes.

Discussion: This experience in lengthening short tubular bones of the feet confirms the efficacy of the techniques used which provided good cosmetic and anatomo-functional results with one treatment.