Metatarsus Adductus

Metatarsus Adductus

Metatarsus Varus; Forefoot varus

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

A.D.A.M. Medical Encyclopedia

Causes, Incidence & Risk Factors – Symptoms – Signs & Tests

Expectations (Prognosis) – Treatment – Complications – Calling Your Health Care Provider

From Wikipedia – The Free Encyclopedia

What is Metatarsus Adductus? – What Causes Metatarsus Adductus? – How is Metatarsus Adductus Diagnosed?

Treatment for Metatarsus Adductus – What are Long Leg Casts? – Cast Care Instructions

When to Call Your Child’s Physician – Long-Term Out Look for a Child with Metatarsus Adductus

—Causes, Incidence & 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 & 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.

From Wikipedia – The Free Encyclopedia

—What is 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 “non-flexible” (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 
and affects girls and boys equally.

Other causal factors include the following:

  • family history of metatarsus adductus
    • position of the baby in the uterus, especially with breech presentations
    • sleeping position of the baby 
    (babies sleeping on their stomach may increase 
    the tendency of the feet to turn inward)

Babies born with metatarsus adductus may also be at increased risk 
of having an associated hip condition 
known as developmental dysplasia of the hip (DDH). 
DDH is a condition of the hip joint in which the top of the thigh (femur) 
slips in and out of its socket, 
because the socket is too shallow to keep the joint intact.

—How is Metatarsus Adductus Diagnosed?

A physician makes the diagnosis of metatarsus adductus with a physical examination. 
During the examination, the physician 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 (a diagnostic test which uses invisible electromagnetic energy beams 
to produce images of internal tissues, bones, and organs onto film) 
of the feet are often done in the case of non-flexible 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 non-flexible, or stiff foot.

—Treatment for Metatarsus Adductus:

Specific treatment for metatarsus adductus will be determined 
by your child’s physician based on:

  • your child’s age, overall health, and medical history
    • the extent of the condition
    • your child’s tolerance for specific medications, procedures, or therapies
    • expectations for the course of the condition
    • your opinion or preference

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

  • observation, for those with a supple, or flexible, forefoot
    • 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 physician 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 rare instances, the foot does not respond to the stretching program, 
and 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 last shoes may be prescribed 
to help hold the forefoot in place. 
Straight last shoes are made without a curve in the bottom of the shoe.

For those 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 are Long Leg Casts?

Long leg casts are applied from the upper thigh to the foot. 
These casts are used for thigh, knee, or lower leg fractures. 
They can also be used with knee dislocations or after surgery on the leg or knee area

—Cast Care Instructions:

  • Keep the cast clean and dry.
    • Check for cracks or breaks in the cast.
    • Rough edges can be padded to protect the skin from scratches.
    • Do not scratch the skin under the cast by inserting objects inside the cast.
    • Use a hairdryer placed on a cool setting to blow air under the cast 
    and cool down the hot, itchy skin. Never blow warm or hot air into the cast.
    • Do not put powders or lotion inside the cast.
    • Cover the cast while your child is eating to prevent 
    food spills and crumbs from entering the cast.
    • Prevent small toys or objects from being put inside the cast.
    • Elevate the cast above the level of the heart to decrease swelling.

—When to Call Your Child’s Physician:

Contact your child’s physician if your child develops one or more of the following symptoms:

  • fever greater than 101° F
    • increased pain
    • increased swelling above or below the cast
    • complaints of numbness or tingling
    • drainage or foul odor from the cast
    • cool or cold toes

—Long – Term Out Look for a Child with Metatarsus Adductus:

Metatarsus adductus is a common problem that can be corrected. 
Regardless of how much the forefoot turns inward, 
starting treatment immediately after birth improves your child’s prognosis.