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The response to the question below was authored by Marc Mitnick DPM
missing 5th matatarsal
by Jaime
(Bartow, FL)
My daughter was born with a missing 5th matatarsal in her right foot. Now that she is walking and getting older, I have noticed that her leg is bowed in a little bit, she does not really favor that foot any. But I was wondering if there was anything that I could have done so that it begins to grow normally, and that we will be able to find shoes that will fit her properly. She was born with her 5th toe, but after x-rays were done they had decided to just tie the toe off and let it fall off itself. there was no bone for the toe to attatch too. She is missing the entire bone from her ankle to her toe. That being the case, her foot is more narrow then the other, and sometimes she will complain that her hip hurts, I was wondering if there might be any connection between the two.
ANSWER
Hi Jaime,
This is an interesting case as I am not sure that I have ever come across a situation where a fifth metatarsal bone is missing only on one foot.
The problem here as your daughter ages, is going to be the ability of the left foot to "function" as close to normal as possible.
In a normal gait, after the heel hits the ground the foot comes down and body weight is picked up on the outside of the foot (the fifth metatarsal) where it is then passed on to the ball of the foot and the last part is "toe-off" where the foot propels the body to the next step.
The obvious issue here is that your daughter
Over the years I have seen patients who are missing bones on the outside of their foot either from accidents or surgery and they are able to ambulate.
I would actually have to see your daughter walk to give definitive treatment options but on the surface it seems to me she will require at the very least a custom orthotic which is a device that is placed in her shoe in an effort to better balance the foot. Off the top of my head, I am thinking of an orthotic that is built up on the lateral side to make up for the lack of a fifth metatarsal bone. This would stabilize her foot somewhat during midstance and in theory would allow her to get through her gait cycle.
You do not mention your daughter's actual age but I take it she is anywhere from 2-5 years old. I would recommend you take her to a foot specialist who can access her gait in regards to her foot and the bowing of her leg.
One of the ways that people compensate for bowing of the tibia is to pronate which means they actually put less pressure on the outside of their foot.
I think the doctor that you see will have to take the bowing into account when devising an orthotic. This is not a cut and dry situation and make take a little experimentation on the part of you and the doctor to find an orthotic that is helpful to your daughter. Good luck.
Marc Mitnick DPM
DISCLAIMER:
ADDITIONAL REFERENCES
University of Rochester Medical Center
American Academy of Pediatrics
Columbia University Department of Rehabilitation
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