Abstract：Objective To compare the effect between one-stage metatarsal lengthening and gradual metatarsal lengthening for congenital brachymetatarsia.Methods From March 1997 to January 2021 33 patients with 4th congenital brachymetatarsia were treated in the 910th hospital of PLA.There were 2 males and 32 females，and the average age was (30.06±6.94) years.All patients were divided into 2 groups：13 patients in one-stage lengthening group were treated with one-stage metatarsal lengthening and 20 patients in gradual lengthening group with gradual metatarsal lengthening with external fixators.Information about metatarsal lengthening，index of bone healing，AOFAS，time of internal fixation and time of full load，level of satisfaction and comfort，and complications were recorded. Results All patients were followed up for (19.83±4.50) months.Metatarsal short length，metatarsal lengthening length，ratio of 4th and 2nd metatarsal length and toe short length in gradual lengthening group were superior than onestage lengthening group (P＜0.01)，but it was equal in 2 groups about index of bone healing (P＞0.05).There were no significant difference between 2 groups about time of internal fixation，time of full load，AOFAS and level of comfort (P＞0.05)，but level of satisfaction in gradual lengthening group was superior than one-stage lengthening group (P＜0.01).There were no significant difference between 2 group about delayed bone union，stiffness of the interphalangeal joint，metatarsophalangeal joint pain and pin infection (P＞0.05).Conclusion One-stage metatarsal lengthening only can be used to the mild congenital brachymetatarsia，but gradual metatarsal lengthening with external fixator can be used to all kind of congenital brachymetatarsia，especially for severe petients.The postoperative effect and complications of 2 surgical methods are similar，but patients are more satisfied with gradual metatarsal lengthening.
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