Brachymetatarsia develops from early closure of the growth plate. It typically involves the 4th ray or, less frequently, more than one metatarsal bone. It is related to several genetic conditions and syndromes. Females are almost exclusively affected 1. Supernumerous sesamoids at the MTP joints are most common in the 5th ray and least common in the 4th ray. The incidence in the 1st IP joint is 2% 2.