Cosmetic Foot Fix Brings New Confidence and Sandal Shopping

Her whole life, 20-year-old Kiana Donaldson has wanted to fix the fourth metatarsal on her left foot. Due to a congenital deformity, the toe was so short that it essentially sat on top of her foot, leaving her embarrassed to wear open-toed shoes or go barefoot at the beach or pool.

Thanks to Dr. Nelson Keller at Hampton Roads Orthopaedics Spine & Sports Medicine, who oversaw a multi-step procedure to lengthen the metatarsal, Donaldson recently bought her very first pair of strappy sandals.

“I love it,” she says. “It doesn’t look identical to my other foot, but I think it’s perfect. Dr. Keller is awesome. He was always there for me. He knew how insecure I was about the appearance of my toe, and I felt like he valued that as much as I did. That really meant a lot to me.”

Donaldson was born with a condition called brachymetatarsia, caused when a joint in her toe closed too early during development. In addition to cosmetic concerns, the condition can cause difficulty walking and pain with wearing many types of shoes.

Dr. Keller treated Donaldson with two surgeries. During the first, in March 2018, he precisely cut the bone in her toe and inserted a specialized external fixator device, which attached to the two bone segments with pins. Once a day for about two months, Donaldson turned a knob that very gradually pulled those segments apart, which also stimulated new bone to form in the gap over time.

In May, Dr. Keller removed the fixator and pins in a second surgery. He placed Donaldson in a cast for six weeks as the toe healed, followed by a walking boot and some activity restrictions for another month.

“Everything has to stretch with the bone: the tendons, blood vessels, and nerves,” Dr. Keller explains. “Ultimately, we were able to lengthen her toe about 1½ inches total. We made her foot look ‘normal’ for the first time, and the bone is now completely solid. We were both very happy with the results.”

Dr. Keller sees about five patients a year with brachymetatarsia, most commonly in their fourth toe. Donaldson’s case was one of the more severe, he says. Other than some minor aching as her toe grew, Donaldson had no complications. The scar beneath her toe is of no cosmetic concern to her. In fact, as soon as her cast came off, her mother gave her a pair of Old Navy flip-flops that she had long envied on friends.

“I probably won’t be wearing closed-toed shoes the rest of the year – even in the winter,” she says with a smile. “And I really can’t wait for next summer. I might just live at the pool.”