Purpose: To evaluate the efficacy of distraction osteogenesis for fourth brachymetatarsia. Materials and Methods: Seven patients (10 cases) who were treated by distraction osteogenesis for fourth brachymetatarsia from March 2000 to December 2003 were reviewed retrospectively. Results: The average length gain of fourth metatarsus was 16.6 mm (37%) and the average healing index was 50 days/cm. The final results according to AOFAS functional scale were excellent in 8 cases and good in 2 cases. Conclusion: Distraction osteogenesis is an effective treatment for fourth brachymetatarsia in spite of some minor complications.