Lengthening of brachymetatarsia. A and B, Preoperative clinical photograph and anteroposterior radiograph showing severe brachymetatarsia of second metatarsal. C, Application of distraction fixator with osteotomy and cross pinning of second metatarsophalangeal joint. D and E, After removal of distraction device. F, Ultimately, third and fourth distal metatarsal osteotomies were required for final lengthening. G, Final postoperative result.