Distraction osteogenesis for metatarsal lengthening. External fixator is applied as parallel as possible to axis of second metatarsal in transverse plane (A) and to plantar surface of foot in sagittal plane (B). (Redrawn from Lee KB, Park HW, Chung JW, et al: Comparison of the outcomes of distraction osteogenesis for first and fourth brachymetatarsia, J Bone Joint Surg 92A:2709, 2010.) SEE TECHNIQUE 84.30.