CHAPTER 53

Metatarsus Adductus and Metatarsus Varus

Metatarsus Adductus

INTRODUCTION/ETIOLOGY/EPIDEMIOLOGY

• Metatarsus adductus (MTA) is a common foot deformity.

• The forefoot deviates medially with respect to the hindfoot, giving the foot a bean-shaped appearance such that the lateral aspect of the foot is convex.

• Incidence is 1 per 1,000 live births.

• Some authors have postulated a relationship between MTA and hip dysplasia because of in utero positioning and molding. The incidence of hip dysplasia in children with MTA ranges from 1% to 13% in some series, while others have found no correlation between the 2 disorders.

SIGNS AND SYMPTOMS

• One or both feet curve medially (Figure 53-1).

• The forefoot is flexible and can easily be positioned into normal alignment with the hindfoot.

Figure 53-1. Heel bisector line to evaluate medial deviation of the foot at the tarsometatarsal joint.

Reprinted with permission from Bleck WW. Developmental orthopaedics III: toddlers. Develop Med Child Neurol. 1982;24:533-534.

• The examiner can stimulate the inside and outside of the foot, which stimulates the foot to abduct. Active correction of the deformity by the child is a good prognostic factor.

DIFFERENTIAL DIAGNOSIS

• Metatarsus varus

• A “searching” or “seeking” great toe

— The tendency for the foot to deviate medially may not be noticed at birth. When the child stands and walks, the great toe abductor muscles pull the forefoot medially due to a primitive grasping reflex.

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