ADVANCED FOOT AND ANKLE SPECIALISTS, PA
Jay S. Weingarten, DPM, FACFAS, FACFAOM
Podiatric Physician and Surgeon
Board Certified Physician – Treating Pediatrics to Geriatrics
Metatarsus Adductus
Metatarsus adductus is a congenital deformity of the foot where there is
increased curvature of the forefoot. This gives the foot the appearance of a "C"
shape. This deviation of the metatarsals or visual effect of in-toeing is a
deformity that occurs at the midfoot of the foot. The diagnosis of metatarsus
adduction is relatively straightforward and is predominantly a clinical diagnosis.
The exact cause of metatarsus adductus is not fully understood but is
considered to be caused by intrauterine position and pressures. There may also
be a genetic component to the deformity.
Diagnosis
The diagnosis of metatarsus adductus is made by physical examination and has
certain characteristics:
 the foot has an inward position as compared to the lower leg
 the foot has a concave border medially and a convex border laterally
 the metatarsus adductus foot may appear with a high arch
 there is usually a separation of the big toe from the lesser toes
Treatment
Non Operative Treatment
Most children with the metatarsus adductus deformity can be treated with
conservative measures. Mild flexible cases can be treated with stretching and
strengthening modalities, braces, orthoses, or straight last or reverse last shoe
gear. In some cases serial casting may be necessary. This consists of applying
plaster to the foot reducing the deformity. The cast is changed every 7 to 14
days. Casting is recommended until the deformity is reduced and then for half
the amount of time again. In other words if it takes 6 weeks of casting to
reduce the deformity then the infant should be cast for an additional three
weeks. In those children who require casting those treated prior to the age of
ambulation have more favorable results, but that doesn't mean that those with
the deformity shouldn't be treated after ambulation begins. In cases where the
deformity is resistant to conservative treatment or the deformity is rigid,
surgical treatment may be considered.
Operative
Operative treatment is reserved for deformities that have been neglected or
have not responded to non-operative treatments. If surgery is required there
are several different procedures depending on the age of the patient and the
magnitude of the deformity. In less severe cases, soft tissue releases or
tendon transfers can correct the deformity. While in more severe cases bony
cuts and repositioning is the best treatment option. Following any type of
surgical correction braces, orthoses or orthopedic shoes may be required.
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