synonyms: metatarusus adductus, metatarsus varus
Metatarsus Adductus ICD-9
- 754.53(congenital metatarsus varus)
Metatarsus Adductus Etiology / Epidemiology / Natural History
- Congenital medial deviation of the forefoot on the hindfoot with a neutral or slightly valgus heel, first described by Henke (1863).
- Etiology and pathogenesis are unknown, believed to result of intrauterine positioning
- May be isolated or found in conjunction with a clubfoot or a skewfoot.
- 1/5000 live births, 1/20 siblings of pts with metatarsus adductus. Rate higher in males, twins, premature
Metatarsus Adductus Anatomy
- Main anomaly in metatarsus adductus appears to be obliquity of the medial cuneiform-1st MT joint.
Metatarsus Adductus Clinical Evaluation
- c/o=cosmetic, in-toeing gait, excessive shoe wear
- Foot appears C-shaped, concave medial border, convex lateral border
- Hindfoot in neutral or valgus, never varus
- Evaluate for medial skin crease
- Normal ankle & subtalar motion
- Hip and neck should be checked for associated conditions-hip dysplasia and torticollis
Metatarsus Adductus Xray / Diagnositc Tests
- Not indicated in infants
- >4y/o=forefoot adduction, excessive medial deviation at the tarsal-metatarsal joint and a neutral or valgus heal.
- Obliquity of the medial cuneiform-1st MT joint
- Broadened articular surface of the first metatarsal bone
- May have subluxations between 2nd/3rd cuneiform bones and base of 2nd/3rd metatarsal bones
Metatarsus Adductus Classification / Treatment
- Bleck classification (Bleck EE, JPO 1983;3:2-9).
- Flexible=forefoot can be abducted beyond the midline heel-bisector. Commonly resolves without treatment, rarely leads to pain in adulthood. Parental program of gentle stretching may speed recovery to normal posture-Partially flexible=forefoot can be abducted to the midline. Treatment controversial.
- Rigid=can not be abducted to midline. RX=early casting for 6-8 weeks, some will recur after treatment. Surgery indicated for painful shoe wear after failed casting. OR=opening wedge osteotomy of the medial cuneiform, combined with a closing wedge of the cuboid or osteotomies at the base of the second through fourth metatarsals. . For the child with a fixed deformity who is older than age 4 years, multiple metatarsal osteotomies result in a better long-term outcome and a more mobile foot. Since a corrective proximal osteotomy of the first metatarsal cannot be performed because of the proximity of the epiphysis, an opening wedge osteotomy of the medial cuneiform is preferred. In children younger than age 6 years, tarsometatarsal capsulotomies can be performed. Distal release of the abductor hallucis tendon has been advocated in children under age 2 years who have failed to respond to casting. (Bleck EE, JPO 1983;3:2-9).
Metatarsus Adductus Associated Injuries / Differential Diagnosis
Metatarsus Adductus Complications
- Neurovascular injury
- Continued deformity
- Growth arrest
Metatarsus Adductus Follow-up Care
Metatarsus Adductus Review References
- Lincoln, JAAOS 2003;11:312-320
- Farsetti P, et al., “The Long-Term Functional and Radiographic Outcomes of Untreated and Non-operatively Treated Metatarsus Adductus,” JBJS-A, 76-A:257-265.