A longitudinal epiphyseal bracket (LEB) is a defect of the tubular bones and has been primarily described in the hands and feet, especially the proximal phalanges, metacarpals, and metatarsals. The LEB results from a defective C-shaped secondary ossification center that brackets the diaphysis and metaphysis, causing restricted longitudinal growth in these bones with resultant shortening and angular deformities. Deformities associated with metatarsal epiphyseal bracket include a short, broad metatarsal and medial deviation of the metatarsophalangeal joint (hallux varus deformity). Excision of the cartilaginous LEB has been proposed to prevent future soft tissue contractures and osseous deformities. The LEB has been associated with numerous syndromes including Rubinstein-Taybi syndrome, Cenani-Lenz syndactyly, isolated oligosyndactyly, and Nievergelt syndrome. We describe a two-month-old patient in whom plain film and MR imaging demonstrated bilateral bracketed first metatarsals with associated hallux varus deformities. Bilateral bracket excision was performed with excellent clinical results.
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Article Synopsis
- Longitudinal epiphyseal bracket of the first metatarsal is a rare congenital condition that results in abnormal shortness and shape of the first metatarsal bone, leading to a foot deformity called hallux varus.
- This condition affects 2% to 14% of congenital foot and hand defects, is often bilateral (75% of cases), and occurs more frequently in males.
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