METATARSUS ADDUCTUS

Metatarsus Aductus, also known as Metatarsus Varus, refers to a common foot deformity that causes the front half of the foot, or forefoot, to turn inward. Doctors will recognize the deformity during the birthing process.

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Metatarsus Adductus

Metatarsus Adductus refers to a foot deformity that is normally present at birth. It causes the front of the foot (forefoot) to turn inward, while the back of the foot (arch and heel) remains normal. Consequently, Minor cases may go undetected until later stages, when the abnormality may become more pronounced. This condition is relatively common, affecting 1 to 2 out of every 1000 children born, with half of these cases affecting both feet. Also, first-born children appear more vulnerable. Clearly, the long-term outlook for children with Metatarsus Adductus is good, with more than 90% of cases resolving on their own.

It is very common in infants and children under two years old and, when not caused by simple muscle weakness, it is caused by one of three underlying conditions: a twisted shin bone, excessive anteversion (femoral head is more than 15 degrees from the angle of torsion) resulting in the twisting of the thigh bone when the front part of an infants foot turns inward.

Causes

Metatarsus Adductus is a common newborn condition caused by the feet being “packed” in the womb in that position. At this stage, the forefoot adduction is very flexible, and with freedom of movement, this Metatarsus Adductus postural condition often improves over the next 6 to 12 weeks. In about 15% of cases, the adducted position of the forefoot does not improve. In fact, the deformity loses flexibility. Subsequently, a crease appears on the medial border of the foot, and a bony “bump” appears on the lateral border of the foot, right at the forefoot-hindfoot junction. Generally, this is a classic case of Metatarsus Adductus that may necessarily require treatment.

Symptoms

The forefoot is bent or angled toward the center of the foot. In contrast, the ankles and the back of the foot appear normal. One-half of all children with Metatarsal Adductus have these changes in both feet. In addition to metatarsus Adductus, newborns may suffer from hip dysplasia (slipped capital femoral epiphysis). As a result, the thigh bone can slip out of the hip socket. (Club foot is a different issue.) In other words, the foot is turned in and the ankle is pointed down.)

QUESTIONS AND ANSWERS

What constitutes Metatarsus Adductus, and how is it diagnosed?

Metatarsus Adductus refers to a common foot deformity in children in which the front part of the foot, particularly the metatarsal bones, curves inward. Doctors identify the condition by a physical examination. In some cases, doctors will use an X-ray scan to assess the severity of the condition.

What treatment options do doctors use to treat Metatarsus Adductus in children?

The treatment for Metatarsus Adductus in children can vary depending on the severity of the condition. Mild cases may resolve on their own as the child grows, but in more severe cases, treatment options may include:

Stretching exercises and physiotherapy to improve foot flexibility.
Serial casting, which involves applying casts at regular intervals to gradually correct the foot’s alignment.
Orthotic devices, such as special shoes or insoles, to support and correct the foot’s position.
In rare cases, doctors will use surgical intervention for severe and persistent cases.

Will my child outgrow Metatarsus Adductus, and what is the long-term outlook?

Many children with Metatarsus Adductus will naturally outgrow the condition as they continue to grow and develop. The success of treatment options, if required, can also vary. In most cases, early intervention and non-invasive treatments can lead to a good outcome, with normal foot development. The long-term outlook appears positive, but it’s important to follow the guidance of a healthcare professional to monitor and manage the condition effectively.

Parents with concerns about their child’s foot development should consult with a pediatrician or a pediatric orthopedic specialist. They can provide a tailored assessment and treatment plan based on the child’s specific condition and needs.

The doctors at the Medical City Children’s Orthopedics and Spine Specialists Practice only treat children. As such, our doctors have become experts in children’s medical conditions. From mild to the most complex, we are here for your child.

Metatarsus Adductus Diagnosis

A doctor uses a physical examination to diagnose the Metatarsus Adductus. During the examination, the doctor will obtain the child’s complete birth history and ask if any other family members previously possessed metatarsus Adductus. In most cases, doctors do not need diagnostic procedures to evaluate the Metatarsus Adductus. However, in the case of nonflexible Metatarsus Adductus, X-rays (a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film) of the feet are frequently performed.

An infant with Metatarsus Adductus has a high arch, and the big toe is separated from the second toe and deviates inward. Lastly, flexible Metatarsus Adductus is diagnosed when the heel and forefoot align with each other using gentle pressure on the forefoot while holding the heel steady. This is known as passive manipulation. Conversely, a nonflexible, or stiff, foot is difficult to align with the heel.

What Factors Affect Metatarsus Adductus Treatment?

Age, general health, and medical background of your child.
The severity of the illness.
The level of toleration your child has for a given treatment or therapy.
Expectations about how the disease will progress.
Your preference or view.

Treatment

The symptoms, age, and general health of your kid will determine the course of treatment. Additionally, how serious the issue is will determine how it proceeds. However, most children with Metatarsus Adductus do not require treatment. As the child grows, the foot often straightens out. If treatment is required, how easily the affected foot bends will determine it. Nevertheless, the purpose of treatment is to straighten the forefoot and heel. In some situations of metatarsus Adductus, doctors will recommend stretching exercises. In contrast, most children’s conditions resolve on their own.

There are times when your child will need to receive treatment using casts or specific footwear. When a kid has a severe deformity, doctors may occasionally advise surgery for those who are 4 years old or older. Doctors can reshape the foot by a variety of surgical treatments. All of these entail “osteotomy,” or removing particular bones, then “fixing” them with plates or screws so that they become in a straighter position. Treatment may include:

Observation

Children with a flexible forefoot will most likely improve on their own.

Stretching therapy

Doctors frequently advise that stretching aids in getting the forefoot into its usual position. In the notch formed by the parent’s thumb and index finger, the parent holds the child’s heel. The parent then uses the other hand’s thumb and index finger to grip the forefoot while gently pulling toward the little toe.

Casting

If the foot doesn’t start correcting on its own or if the MTA remains stiff or difficult to shift into the right position, doctors will sometimes suggest casting. The casts aid in positioning the foot. The whole leg, from the groin to the toe, becomes enclosed in a cast. Every several weeks, the doctor and staff will replace the cast. Special leg braces are also sometimes employed.

Parents should ensure that the cast remains dry and clean.
Examine the cast for cracks or breaks.
Padding can eliminate rough edges to prevent scratches on the skin.
Avoid scratching the skin beneath the cast by inserting objects inside it.
Use a cool-setting hairdryer to blow air under the cast and cool the hot, itchy skin. Parents should never blow warm or hot air into the cast.
Avoid using powders or lotions inside the cast.
Cover the cast while your child eats to keep food spills and crumbs out of the cast.
Do not insert any small toys or items inside the cast.
To reduce swelling, elevate the cast above the level of the heart.
Shoes with straight laces. Straight laced shoes may be used to help hold the forefoot in place if your child’s foot responds to casting. The bottom of these shoes does not have a curve.

Surgery

Doctors will recommend surgery to release the forefoot joints in infants with very rigid or severe Metatarsus Adductus. Casts are usually applied after surgery to keep the forefoot in place while it heals. According to research, Metatarsus Adductus can resolve spontaneously (without treatment) in the vast majority of affected children. During diaper changes, your child’s doctor may instruct you on how to perform passive manipulation exercises on your child’s feet. Doctors may advise shifting the sleeping positions of your child to the side. Doctors may use long leg casts if the foot does not respond to the stretching program. Casts are used to stretch the forefoot’s soft tissues. Your child’s pediatric orthopedist will change the plaster casts every 1 to 2 weeks.

Straight-laced shoes, without a curve at the bottom, may be prescribed to help hold the forefoot in place if the foot responds to casting.

Is Metatarsus Adductus Treatable Without Surgery?

According to studies, the majority of kids with metatarsus Adductus can get well on their own. Finally, the Pediatric Orthopedic Specialists at the Medical City Children’s Orthopedics and Spine Specialists will examine your child and provide the best treatment based on the condition. For example, one of the best treatments is manipulation exercises on your child’s feet while changing their diaper. In addition, our doctor could also advise you to switch up your child’s sleeping positions. The position of lying on one’s side is one suggestion. For your convenience, we have offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX. Call us for an appointment, we will see your child quickly.

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Footnote:

Physic Pedia: Metatarsus Adductus

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