Correlation between fourth brachymetatarsia and hallux valgus_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIANG Jiachang , FENG Enhui , GUAN Hua , CHEN Pu , HE Jianbo , HUANG Weiming , Xu Yiyin ,  XIE Jiewei

Department of Trauma and Foot-Ankle Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou Guangdong, 510120, P. R. China;

Corresponding?author：

XIE Jiewei, Email: gdszyycszhk@163.com

Keywords：

Fourth brachymetatarsia; hallux valgus; incidence; correlation analysis

DOI：

10.7507/1002-1892.202601023

Video：

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Objective To investigate the correlation between fourth brachymetatarsia and hallux valgus, and to provide evidence-based support for clinical decision-making. Methods A retrospective analysis was conducted on 68 patients (89 feet) with congenital fourth brachymetatarsia treated between August 2021 and November 2025. All patients were female, aged 18-44 years (mean, 28.1 years). The hallux valgus angle (HVA), intermetatarsal angle (IMA), and shortening length of the fourth metatarsal were measured on standardized weight-bearing anteroposterior foot X-ray films. Hallux valgus-related complications were recorded. The prevalence of hallux valgus was compared with the reference value reported for the general adult female population in China (14.74%). Spearman rank correlation analysis was used to evaluate the correlations of HVA and IMA with age and metatarsal shortening length. Results In the entire cohort, HVA ranged from 5.65° to 44.95° (mean, 20.56°), IMA ranged from 6.46° to 20.45° (mean, 11.61°), and the shortening length of the fourth metatarsal ranged from 5.62 to 18.01 mm (mean, 12.05 mm). Hallux valgus was present in 55 feet, giving a prevalence of 61.80%, which was significantly higher than the reference value for the general adult female population in China (Z=12.523, P<0.001). Associated symptoms in feet with hallux valgus included bunion (31 feet, 56.36%), transfer metatarsalgia of the second metatarsal head (16 feet, 29.10%), transfer metatarsalgia of the third metatarsal head (10 feet, 18.18%), plantar callosity (8 feet, 14.55%), and dorsal callosity (4 feet, 7.27%). In patients with hallux valgus, HVA ranged from 15.83° to 44.95° (mean, 26.16°) and IMA ranged from 9.01° to 20.45° (mean, 13.35°). Correlation analysis showed that both HVA and IMA were positively correlated with the shortening length of the fourth metatarsal (r=0.290, P=0.016; r=0.420, P<0.001), whereas no correlation was found between HVA or IMA and age (r=–0.061, P=0.751; r=0.132, P=0.525). Conclusion Patients with fourth brachymetatarsia have a significantly higher prevalence of hallux valgus, which is positively correlated with the degree of metatarsal shortening but not with age, suggesting an anatomical rather than age-related etiology. The study redefines the clinical nature of fourth brachymetatarsia, promoting a paradigm shift from “cosmetic correction” to “functional reconstruction”. It is recommended that this deformity be included as a screening indicator for populations at high risk of hallux valgus.

Citation： LIANG Jiachang, FENG Enhui, GUAN Hua, CHEN Pu, HE Jianbo, HUANG Weiming, Xu Yiyin, XIE Jiewei. Correlation between fourth brachymetatarsia and hallux valgus. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(6): 930-934. doi: 10.7507/1002-1892.202601023 Copy

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2.	Kim HT, Lee SH, Yoo CI, et al. The management of brachymetatarsia. J Bone Joint Surg (Br), 2003, 85(5): 683-690.
3.	Hicks JH. The mechanics of the foot. Ⅱ. The plantar aponeurosis and the arch. J Anat, 1954, 88(1): 25-30.
4.	Mann R, Inman VT. Phasic activity of intrinsic muscles of the foot. J Bone Joint Surg (Am), 1964, 46: 469-481.
5.	梁家暢, 管華, 馮恩輝, 等. Ilizarov技術治療先天性第四跖骨短小癥: 延長比例亞組分析. 中國組織工程研究, 2025, 29(33): 7217-7222.
6.	Buldt AK, Allan JJ, Landorf KB, et al. The relationship between foot posture and plantar pressure during walking in adults: A systematic review. Gait Posture, 2018, 62: 56-67.
7.	Ledoux WR, Shofer JB, Ahroni JH, et al. Biomechanical differences among pes cavus, neutrally aligned, and pes planus feet in subjects with diabetes. Foot Ankle Int, 2003, 24(11): 845-850.
8.	王正義, 姜保國, 唐康來, 等. 踇外翻外科治療專家共識. 中華骨與關節外科雜志, 2018, 11(2): 87-95.
9.	崔賓, 王光義, 劉鐵軍, 等. 昌平沙河地區拇外翻流行病學調查報告. 求醫問藥(學術版), 2012, 10(9): 173.
10.	朱春霖, 曲峰, 張明珠, 等. 踇外翻的病因及流行病學. 足踝外科電子雜志, 2023, 10(2): 83-88.
11.	Cai YT, Song YK, He MC, et al. Global prevalence and incidence of hallux valgus: a systematic review and meta-analysis. J Foot Ankle Res, 2023, 16(1): 63. doi: 10.1186/s13047-023-00661-9.
12.	Siddiqui NA, Mateen S, Thomas MA, et al. Comparing outcomes of acute versus gradual surgical correction in brachymetatarsia. J Foot Ankle Surg, 2024, 63(2): 281-285.
13.	Espinosa N, Maceira E, Myerson MS. Current concept review: metatarsalgia. Foot Ankle Int, 2008, 29(8): 871-879.
14.	Coughlin MJ, Jones CP. Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int, 2007, 28(7): 759-777.
15.	Koller U, Willegger M, Windhager R, et al. Plantar pressure characteristics in hallux valgus feet. J Orthop Res, 2014, 32(12): 1688-1693.
16.	Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. J Bone Joint Surg (Am), 2011, 93(17): 1650-1661.
17.	Menz HB, Marshall M, Thomas MJ, et al. Incidence and progression of hallux valgus: A prospective cohort study. Arthritis Care Res (hoboken), 2023, 75(1): 166-173.
18.	Hofmann UK, G?tze M, Wiesenreiter K, et al. Transfer of plantar pressure from the medial to the central forefoot in patients with hallux valgus. BMC Musculoskelet Disord, 2019, 20(1): 149. doi: 10.1186/s12891-019-2531-2.
19.	Geng X, Shi J, Chen W, et al. Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study. BMC Musculoskelet Disord, 2019, 20(1): 625. doi: 10.1186/s12891-019-2973-6.
20.	鄔博來, 王小軍, 馬智敏, 等. 跖骨即時延長術治療先天性跖骨短小癥. 中國骨傷, 2024, 37(12): 1208-1212.
21.	Li X, Gu J, Wu Y, et al. Treatment of fourth metatarsal brachymetatarsia using distraction osteogenesis with external fixator: Surgical techniques, outcomes and complications. Orthop Surg, 2024, 16(9): 2148-2156.
22.	Peng YN, Peng YH, Chen CPC. Chevron osteotomy and scarf osteotomy for hallux valgus angle and intermetatarsal angle correction: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res, 2024, 19(1): 566. doi: 10.1186/s13018-024-05007-0.
23.	Noback PC, Trofa DP, Vosseller JT. Republication of “Evidence versus practice: operative treatment preferences in hallux valgus”. Foot Ankle Orthop, 2023, 8(3): 24730114231195359. doi: 10.1177/24730114231195359.

1. Schimizzi A, Brage M. Brachymetatarsia. Foot Ankle Clin, 2004, 9(3): 555-570.
2. Kim HT, Lee SH, Yoo CI, et al. The management of brachymetatarsia. J Bone Joint Surg (Br), 2003, 85(5): 683-690.
3. Hicks JH. The mechanics of the foot. Ⅱ. The plantar aponeurosis and the arch. J Anat, 1954, 88(1): 25-30.
4. Mann R, Inman VT. Phasic activity of intrinsic muscles of the foot. J Bone Joint Surg (Am), 1964, 46: 469-481.
5. 梁家暢, 管華, 馮恩輝, 等. Ilizarov技術治療先天性第四跖骨短小癥: 延長比例亞組分析. 中國組織工程研究, 2025, 29(33): 7217-7222.
6. Buldt AK, Allan JJ, Landorf KB, et al. The relationship between foot posture and plantar pressure during walking in adults: A systematic review. Gait Posture, 2018, 62: 56-67.
7. Ledoux WR, Shofer JB, Ahroni JH, et al. Biomechanical differences among pes cavus, neutrally aligned, and pes planus feet in subjects with diabetes. Foot Ankle Int, 2003, 24(11): 845-850.
8. 王正義, 姜保國, 唐康來, 等. 踇外翻外科治療專家共識. 中華骨與關節外科雜志, 2018, 11(2): 87-95.
9. 崔賓, 王光義, 劉鐵軍, 等. 昌平沙河地區拇外翻流行病學調查報告. 求醫問藥(學術版), 2012, 10(9): 173.
10. 朱春霖, 曲峰, 張明珠, 等. 踇外翻的病因及流行病學. 足踝外科電子雜志, 2023, 10(2): 83-88.
11. Cai YT, Song YK, He MC, et al. Global prevalence and incidence of hallux valgus: a systematic review and meta-analysis. J Foot Ankle Res, 2023, 16(1): 63. doi: 10.1186/s13047-023-00661-9.
12. Siddiqui NA, Mateen S, Thomas MA, et al. Comparing outcomes of acute versus gradual surgical correction in brachymetatarsia. J Foot Ankle Surg, 2024, 63(2): 281-285.
13. Espinosa N, Maceira E, Myerson MS. Current concept review: metatarsalgia. Foot Ankle Int, 2008, 29(8): 871-879.
14. Coughlin MJ, Jones CP. Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int, 2007, 28(7): 759-777.
15. Koller U, Willegger M, Windhager R, et al. Plantar pressure characteristics in hallux valgus feet. J Orthop Res, 2014, 32(12): 1688-1693.
16. Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. J Bone Joint Surg (Am), 2011, 93(17): 1650-1661.
17. Menz HB, Marshall M, Thomas MJ, et al. Incidence and progression of hallux valgus: A prospective cohort study. Arthritis Care Res (hoboken), 2023, 75(1): 166-173.
18. Hofmann UK, G?tze M, Wiesenreiter K, et al. Transfer of plantar pressure from the medial to the central forefoot in patients with hallux valgus. BMC Musculoskelet Disord, 2019, 20(1): 149. doi: 10.1186/s12891-019-2531-2.
19. Geng X, Shi J, Chen W, et al. Impact of first metatarsal shortening on forefoot loading pattern: a finite element model study. BMC Musculoskelet Disord, 2019, 20(1): 625. doi: 10.1186/s12891-019-2973-6.
20. 鄔博來, 王小軍, 馬智敏, 等. 跖骨即時延長術治療先天性跖骨短小癥. 中國骨傷, 2024, 37(12): 1208-1212.
21. Li X, Gu J, Wu Y, et al. Treatment of fourth metatarsal brachymetatarsia using distraction osteogenesis with external fixator: Surgical techniques, outcomes and complications. Orthop Surg, 2024, 16(9): 2148-2156.
22. Peng YN, Peng YH, Chen CPC. Chevron osteotomy and scarf osteotomy for hallux valgus angle and intermetatarsal angle correction: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res, 2024, 19(1): 566. doi: 10.1186/s13018-024-05007-0.
23. Noback PC, Trofa DP, Vosseller JT. Republication of “Evidence versus practice: operative treatment preferences in hallux valgus”. Foot Ankle Orthop, 2023, 8(3): 24730114231195359. doi: 10.1177/24730114231195359.

Chinese Journal of Reparative and Reconstructive Surgery

Correlation between fourth brachymetatarsia and hallux valgus

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