Cath Lab Digest

Yes, this author advocates early treatment for moderate to severe metatarsus adductus, and semi-rigid or rigid deformity. He cites problematic compensatory effects from residual deformities and a documented association between metatarsus adductus and hallux abducto valgus deformity.

Metatarsus adductus is a transverse plane congenital deformity with adduction of the forefoot at the tarsometatarsal joint. It has a reported incidence of one per 1,000 live births. However, it has been acknowledged that this may reflect only the severe cases and the true incidence may be higher.
Researchers have also reported that the incidence increases to 5 percent when one sibling has the deformity.¹ In another study, which followed 484 premature children and 114 healthy-term children for five years after birth, the study authors found metatarsus adductus to be more frequent in twins (41 percent) than in single infants (16 percent). They reported similar frequency in single pre-term and term infants (16 percent versus 12 percent).²
There are several clinical factors to consider with metatarsus adductus and one must weigh these factors in determining if treatment should begin. These factors include:
• the natural history of the deformity including the likelihood of it persisting without treatment;
• potential compensations for the adducted forefoot when the condition persists;
• significance of residual deformity as the child becomes an adult; and
• the reported increased incidence of hallux abducto valgus deformity in the presence of underlying metatarsus adductus.
In advocating for treatment of this condition in select cases, we must consider the reported outcomes for conservative correction of this deformity in infants.
What about congenital foot deformities that you have deemed likely to persist and thereby contribute to compensatory or associated deformities with or without symptomatology? You should ideally correct these deformities in infancy prior to weightbearing. In doing so, podiatrists can “optimize” the foot before the effects of ground reaction force, the superstructure above and shoe gear are introduced. These post-weightbearing factors can contribute to the development of secondary problems over time.