Metatarsus adductus

Answer 1

Definition

Metatarsus adductus is a foot deformity. The bones in the middle of the foot bend in toward the body.

Alternative Names

Metatarsus varus; Forefoot varus

Causes, incidence, and risk factors

Metatarsus adductus is thought to occur as a result of the infant's position inside the womb.

This is a relatively common disease affecting about one out of every 1,000 to 2,000 live births. Risk factors may include a condition called oligohydramnios in which the pregnant mother does not produce enough amniotic fluid.

Symptoms

The front of the foot is bent inward. The back of the foot and the ankles are normal. (With a club foot, which is a different deformity, the foot will be pointed down and the ankle turned in.)

Signs and tests

Physical examination is all that is needed to diagnose metatarsus adductus.

Treatment

Treatment depends on the severity of the deformity. In most children, the problem corrects itself as normal use of the feet develops. Such cases do not need any treatment.

Stretching exercises may be needed when the problem does not go away with normal use of the foot. These are done if the foot can be easily moved into a normal position.

Rarely, this disease causes a rigid deformity that cannot be corrected with stretching exercises. In these cases, casting and even surgery may be needed. Other conditions may need to be considered in these children. A pediatric orthopaedic surgeon should be involved in treating more severe deformities.

Expectations (prognosis)

The outcome is excellent. Nearly all patients eventually have a normal looking, fully functional foot.

Complications

Developmental dislocation of the hip may be associated with a small number of infants with metatarsus adductus.

Calling your health care provider

Call your health care provider if you are concerned about the appearance or flexibility of your infant's feet.

Answer 2

Definition

Metatarsus adductus is a foot deformity. The bones in the front half of the foot bend or turn in toward the body.

Alternative Names

Metatarsus varus; Forefoot varus

Causes, incidence, and risk factors

Metatarsus adductus is thought to be caused by the infant's position inside the womb. Risks may include:

• The baby's bottom pointed down in the womb (breech position)
• The mother had a condition called oligohydramnios, in which she did not produce enough amniotic fluid

There may also be a family history of the condition.

Metatarsus adductus is a fairly common problem. It is one of the reasons why people develop "in-toeing."

Newborns with metatarsus adductus often have a problem called developmental dysplasia of the hip (DDH), in which the thigh bone slips out of the hip socket.

Symptoms

The front of the foot is bent or angled in toward the middle of the foot. The back of the foot and the ankles are normal. About half of children with metatarsus adductus have the problem in both feet.

(Club foot is a different deformity. The foot is pointed down and the ankle is turned in.)

Signs and tests

Physical examination is all that is needed to diagnose metatarsus adductus.

A careful exam of the hip should also be done to rule out other causes of metatarsal adductus.

Treatment

Treatment depends on how rigid the foot is when the doctor tries to straighten it.

If the foot is very flexible and easy to straighten or move in the other direction, no treatment may be needed. You child will be followed closely for a period of time.

In most children, the problem corrects itself as they use their feet normally. They don't need any further treatment.

If the problem does not improve or your child's foot is not flexible enough, other treatments will be tried:

• Stretching exercises may be needed. These are done if the foot can be easily moved into a normal position. The family will be taught how to do these exercises at home.
• Your child may need to wear a splint or special shoes, called reverse-last shoes, for most of the day. These shoes hold the foot in the correct position.

Rarely, your child will need to have a cast on the foot and leg. Casts work best if they are put on before your child is 8 months old. The casts will probably be changed every 1 - 2 weeks.

Surgery may be needed, but not very often. Most of the time, your doctor will delay surgery until your child is between 4 and 6 years old.

A pediatric orthopaedic surgeon should be involved in treating more severe deformities.

Expectations (prognosis)

The outcome is almost always excellent. Nearly all patients eventually have a normal looking and working foot.

Complications

A small number of infants with metatarsus adductus may have developmental dislocation of the hip.

Calling your health care provider

Call your health care provider if you are concerned about the appearance or flexibility of your infant's feet.

References

Hosalkar HS, Spiegel DA, Davidson RS. The foot and toes. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 673.

Reviewed By

Review Date: 10/31/2010

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.