Metatarsus Adductus

Metatarsus adductus, also known as metatarsus varus, is a common foot deformity noted at birth that causes the front half of the foot, or forefoot, to turn inward. Metatarsus adductus may also be referred to as “flexible” (the foot can be straightened to a degree by hand) or “nonflexible” (the foot cannot be straightened by hand).

What causes metatarsus adductus?

The cause of metatarsus adductus is not known. It occurs in approximately one out of 1,000 to 2,000 live births.

Babies born with metatarsus adductus rarely need treatment. They may, however, be at increased risk for developmental dysplasia of the hip (DDH).

How is metatarsus adductus diagnosed?

A doctor makes the diagnosis of metatarsus adductus with a physical exam. During the exam, the doctor will obtain a complete birth history of the child and ask if other family members were known to have metatarsus adductus.

Diagnostic procedures are not usually necessary to evaluate metatarsus adductus. However, X-rays of the feet are often done in the case of nonflexible metatarsus adductus.

An infant with metatarsus adductus has a high arch and the big toe has a wide separation from the second toe and deviates inward. Flexible metatarsus adductus is diagnosed if the heel and forefoot can be aligned with each other with gentle pressure on the forefoot while holding the heel steady. This technique is known as passive manipulation.

If the forefoot is more difficult to align with the heel, it is considered a nonflexible, or stiff, foot.

How is metatarsus adductus treated?

The goal of treatment is to straighten the position of the forefoot and heel. Treatment options vary for infants, and may include:

•    Observation
•    Stretching or passive manipulation exercises
•    Casts
•    Surgery

Studies have shown that metatarsus adductus may resolve spontaneously (without treatment) in the majority of affected children.

Your child’s doctor or nurse may instruct you on how to perform passive manipulation exercises on your child’s feet during diaper changes. A change in sleeping positions may also be recommended. Suggestions may include side-lying positioning.

In the rare instance that the foot does not respond to the stretching program, long leg casts may be applied. Casts are used to help stretch the soft tissues of the forefoot. The plaster casts are changed every one to two weeks by your child’s pediatric orthopaedist.

If the foot responds to casting, straight cast shoes may be prescribed to hold the forefoot in place. Straight last shoes are made without a curve in the bottom of the For those few infants with very rigid or severe metatarsus adductus, surgery may be required to release the forefoot joints. shoe.

For those few infants with very rigid or severe metatarsus adductus, surgery may be required to release the forefoot joints. Following surgery, casts are applied to hold the forefoot in place as it heals.

What is the long-term outlook for a child with metatarsus adductus?

Most metatarsus adductus corrects spontaneously. In the few children who require treatment, the treatment is usually successful.