The authors present a case of congenital idiopathic brachymetatarsia of the fourth metatarsal. A combination of techniques was used to address the components of the deformity and its correction, which include preoperative soft tissue stretching, Z-skin plasty, Z-tendon lengthening, Z-lengthening metatarsal osteotomy with internal screw fixation, and bone allografting. Conventional autograft harvesting complications and external fixation were avoided. This case demonstrates the correction of a brachymetatarsal using combined and modified techniques.