Here is an example of a patient that had a really short fourth toe. The technical term is called brachymetatarsia and this is a condition where the toe is actually shortened in the middle of the foot called the metatarsal bone.  Since that area is too short, the toe looks like a midget and so in order to treat this there are a lot of different options. The option that we chose here is something called lengthening of the metatarsal and we use something called an external fixator, which is this little black device that goes on the top with a few little pins that go inside.  So what happens for this patient, you actually make a little incision on top and you cut through the bone in a proper position and you put two pins before the cut and two pins after the cut and you put that little black device on there.  Then every day you want to increase the length about a millimeter until it’s out to the proper length, and you also see in this picture, coming out of the toe there’s a little pin and that’s just to hold the toe in the proper position so that it doesn’t cock up during this process of lengthening this short toe or brachymetatarsia. 
To Your Health,
Dr. Donald Pelto