Metatarsus adductus (metatarsus varus below)
- most common congenital foot anomaly
- caused by intrauterine positioning; usually b/l
- a cause of intoeing
- Physical exam
- metatarsals are deviated medially, causing front part of foot to turn
- lateral margin of foot in the shape of a"C"
- normally, a line drawn bisecting the heel will point to between 2nd/3rd
toe; if it falls more lateral, ~ is present
- hindfoot in valgus (rule out clubfoot! In clubfoot both fore/hindfoot
are in fixed varus))
- stroking foot will result in peroneal muscle contraction, and active
correction. Only partial correction in severe cases.
- metatarsus adductus refers to a flexible deformity, aka positional
- metatarsus varus refers to a fixed structural deformity, aka structureal
- May have an associated
internal tibial torsion.
- May be an association of ipsilateral hip dysplasia with unilateral
metatarsus adductus, so perform a good hip exam.
Treatment depends on severity of condition
- mild cases: passive
manipulation by mother several times a day (stretching exercises if on exam
forefoot can be brought passively over past neutral)
- moderate cases, a combination
of manipulative stretching and reverse or straight last shoes
- severe cases (structural metatarsus, not passively correctible, prominent
deformity and skin crease: serial manipulation and casting for 6-8 weeks.
Undertake tx before ambulation.
- Metatarsus varus refers to a rigid deformity, aka structural metatarsus
- arch looks greater than nl, may be medial crease/deep
medial cleft at middle
portion of arch; forefoot can't be abducted past midline. Ortho consult. Due
to subluxation of tarso-metatarsal joints, when the foot is dorsiflexed.
CHLA Board Review 2005