Lengthening Toes -- In-Depth Doctor's Interview
Bradley Lamm, DPM, Orthopedic Surgeon at Rubin Institute for Advanced Orthopedics at LifeBridge Health talks about a new procedure for lengthening bones.
We’re talking about the new toe procedure you have for what condition?
Dr. Lamm: It’s called Brachymetatarsia.
Can you tell me a little bit about that?
Dr. Lamm: Brachymetatarsia is a congenital deformity of the toe meaning that the toe does not grow the appropriate length. It’s a fairly common birth defect that affects maybe 1 in 2000 to 1 in 5000 people, so it’s a very common congenital abnormality.
I know it is cosmetic but it can cause other issues as well, can you tell me about those?
Dr. Lamm: Yes, so since I treat patients from all over the United States and all over the world I see this condition in younger and older patients and the younger patients have some pain and the cosmetic concern. As patients age with this condition, the functional concerns and the deformity progresses such that they get severe problems like bunions, hammer toes, calluses and pain with various shoe gear.
The patient we talked to yesterday said she had problems of balance.
Dr. Lamm: Yes exactly. The balance issue, the strength of the foot, these are things that are affected with this condition of the short toe.
Is it something that can get worse with time?
Dr. Lamm: Yes, as mentioned before, this condition can get worse with age with more deformities and pain persists more with time.
Before this was available, what were the options for these people? What could they have done about it?
Dr. Lamm: Yes, traditionally you can adjust the shoes or put inserts inside, but this is not always a significant changing treatment. People still have pain and still have shoe irritation and functional problems so there are surgical treatments now and I developed new methods to help these patients.
And the new method, could you tell me about that?
Dr. Lamm: The new surgical method that I developed is to not only lengthen the bone gradually by growing the metatarsal bone, but also to preserve the function of the toe joint. Bone lengthening has been around for a long time but not only lengthening the bone but also preserving the function is the goal. My method of protecting the toe joint function while simultaneously lengthening has been an excellent treatment for these patients and has been very successful.
Now these patients, after they get the procedure what do they have to do and what kind of therapy?
Dr. Lamm: The surgery itself is an overnight stay in the hospital where patients come in and we work with physical therapy the next day after the procedure and their walking the first day after surgery. Therapy is intensive. This means that every day they have to walk and continue to get around because that helps the bone to heal by bearing weight on the feet while it’s healing. So long-term, once the fixator’s are removed and they are in the healing process, then they’ll do formal physical therapy where they’ll get their motion back and their normal gait.
When can they start walking?
Dr. Lamm: Immediately after surgery the first day, which patients love because then they can be more independent. They can take care of their families, go to work, do things like showering within a week after surgery. So this is what is advantageous about this procedure.
And this condition, it can affect you personally, like the patient we talked to before she said she couldn’t do things with her kids like going to the beach and the pool.
Dr. Lamm: Yes, a lot of patients come to me with issues of concern about their feet and the way they look as far as the cosmetic concerns, but also a lot of functional concerns where shoe gear is limited or it’s painful with walking. This is definitely a functional concern and that’s what she had.
How many patients have you treated with it?
Dr. Lamm: I’ve treated over 500 patients with this condition and this is a condition which is again, like I said, not too uncommon.
I see pins and stuff, can you kind of explain exactly what you do?
Dr. Lamm: Yes, the process of the gradual bone lengthening is a gradual dynamic process. It’s very important that the patient and doctor are on the same page and work together. Basically, after the initial surgery, the patient turns the device on their own at home as I instruct. They turn one turn in the morning and one turn at night and this gradual turning is growing the bone. We follow them biweekly in the office by evaluating x-rays as far as how the bone is growing. Once we know that the bone is out to length, the second phase of the treatment is the healing process. First is the lengthening process then the healing process where the bone then has to heal and consolidate and become hard so that we can remove the device.
How long do they have to turn it?
Dr. Lamm: Usually one month is the average amount of time to do the adjustments. Then two to three months of healing until the bone is fully consolidated, so it’s a three to four months process from start to finish. But even though it takes some time, it’s time well invested because patients are very pleased with the result, not only cosmetically but functionally.
Now is this a onetime thing or is there a chance it will suck back open?
Dr. Lamm: That’s a great question. The treatment is a forever treatment. Meaning that once you have this done it’s not going to reoccur or rebound. Now the bone is at the correct length so that you can function well and not have to worry about it.
And why do you think patients aren’t taking advantage of this? The person we talked to said she waited and waited until she finally did it.
Dr. Lamm: This condition is not well known and not well researched or treated. A lot of patients go day-to-day and don’t know that there is an option out there, the option that I’m providing. With this gradual growing of your own bone, you don’t have hardware remaining after the surgery. You can walk right after surgery. This is a very advantageous method of treating this and very successful and now patients are finally getting to me and understanding there is a treatment for this condition.
Now how do patients find out about this condition, I mean if you’re born with it you kind of think maybe this is just a birth defect.
Dr. Lamm: Right, right. A lot of patients come to me saying that they didn’t realize there was treatment until they researched on the Internet and found me through the Internet. YouTube and other social media’s of chat groups have brought me a lot of patients because of my other patients that have talked about me and said that this treatment is successful and that there is a treatment out there that can be successful and can be very complementary to getting them doing what they want to do.
Has there ever been a case where it doesn’t work?
Dr. Lamm: There are cases where we have certain hurdles in the process of treatment, but I’ve been successful in getting someone to their goal, which is getting the length that we need. Sometimes there are some hurdles that come about with the treatment, but since my method has been performed a lot, these hurdles are few and easily achievable.
Did you come up with the device?
Dr. Lamm: The modification of it, yes.
So you came up with it?
Dr. Lamm: Yes, this technique that I have been using is a modification of an original technique of lengthening the fourth metatarsal bone or short metatarsal bone. What it does is it basically is a specially made device that protects the toe, or as mentioned before, the toe joint so that there’s no stiffness after surgery. A lot of patients would have the lengthening and have some stiffness and lack of function of the big toe after surgery. But with this modification, now patients are ranging of the motion of their toe just as normal and there’s no functional deficit with this modification that I’ve invented.
So you’re the only one using it?
Dr. Lamm: This special technique that I use is something that I’ve developed and is strictly used mainly only at our institution here by myself, yes.
Have you thought about a patent?
Dr. Lamm: Yes, the instruments are very much the same as we’ve always used, it’s just the way I have used them that allows the toe to maintain its function after we gain the length.
So does insurance cover any of this?
Dr. Lamm: Yeah so that’s a good question. A lot of patients asked me if this is covered by insurance and yes, since it is a congenital or birth defect, it is covered by insurance plans and it also is a functional concern which creates other deformities and therefore it’s something that has no issues with insurance.
What are patients most concerned about when you explain the procedure to them?
Dr. Lamm: Most are concerned about whether it’s going to hurt when I do that turning or the lengthening and it really doesn’t hurt like you would think. You’d get a shot or a severe pain when you do the turn. It’s really more like you’ve gone to the gym and did some stretching and pulled your muscle a little bit. Usually what patients describe is that it’s a pulling feeling, not really a pain feeling. The other important thing with this gradual lengthening is that we can go a rate which is comfortable. It’s not something that is very painful because it’s such a short distance small amount turn.
This is pretty exciting for you isn’t it. I mean you’re really helping a lot of people.
Dr Lamm: Yes it’s very exciting because a lot of patients come to me with these concerns for a long time and they’re very happy to have found me to help them with getting back on their feet and functional. One lady told me she has never showed her husband her feet because she was so concerned about the look of them and she had pain and she just didn’t know what to do. I helped her and now she’s showing her feet off to everybody.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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If you would like more information, please contact:
Bradley Lamm, DPM
Rubin Institute for Advanced Orthopedics
To read the full report, Lengthening Toes, click here.