Metatarsus Adductus

Wikis > Paediatrics > Metatarsus Adductus

Relatively common presentation during infancy (maybe 1:1000 live births). Abduction of the metatarsals at the tarsometatarsal joints associated with a normal alignment of the rearfoot; 50% bilateral.

Three primary types:
1) Metatarsus adductus (transverse plane only)
2) Metatarsus adductus varus (transverse and frontal plane)
3) ‘Skewfoot’/compensated metatarsus adductus (Z feet; serpentine foot) – metatarsus adductus varus with rearfoot inverted (need to check if inverted or everted).

Aetiology unknown – congenital and environmental factors have been implicated – does resemble foot at about 6th to 8th foetal week.

Clinical features:
Adducted forefoot; medial border is concave; lateral border convex – styloid process of fifth metatarsal base is prominent; often have wider space between first and second toes; heel may be everted or normal.

May have medial skin crease at level of tarsometatarsal joints.

Will generally have no limitation of motion at the ankle joint that occurs in talipes equinovarus.

Can be rigid, semirigid/semiflexible or flexible.

Treatment:
Most minor cases resolve spontaneously. Presence of medial skin crease is indicative of need for treatment.
Flexible  manipulation/stretching by parents + casting.
Casting is preferable before child is ambulatory (rearfoot is held neutral or slightly inverted and forefoot is held abducted by apply counter pressure after cuboid and fifth metatarsal base is stabilised)
Rigid or unresponsive to casting  surgery.
Follow up treatment with orthoses, padded shoes or bars/splints.

 
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