Child Metadductus

METADDUCTUS
By:  Robert H. Sheinberg, D.P.M., D.A.B.F.A.S., F.A.C.F.A.S.

CONDITION:

  • A deformity of the front part of the foot in which all of the metatarsals are positioned to the inside of the foot.

CAUSE:

  • Intrauterine position.
  • Hereditary predisposition.
  • Hyperactive muscle (tibialis anterior, tibialis posterior muscle or abductor hallucis).
  • Abnormal bone or joint structure.

SIGNS AND SYMPTOMS:

  • The front half of the foot is turned in relative to the back half of the foot.
  • Foot may turn up and in, causing a crease of skin on the inner arch.
  • Foot is shaped like a “C” when viewing it from the sole.
  • May be associated with rotational problems of the lower leg (internal tibial torsion).
  • Excessive space between the first and second toes.
  • Prominent bone (fifth metatarsal) on the outside of the foot.
  • May be associated with the curvature to the heel bone (calcaneal varus).

ASSOCIATED PROBLEMS:

  • Juvenile bunion and hammertoe deformities.
  • Lateral drifting of all the digits as the tendons on the top of the foot pull the toes to the outside.
  • Stress fractures to the outside bones in teenagers and adults.
  • Arthritis in adults due to the abnormal joint positions.

TREATMENT:

  • Identify the level of the problem (foot, ankle or leg) and the foot’s flexibility.
  • Identify any muscle hyperactivity.
  • Corrective shoes and occasionally night splinting.
  • Casting of the foot and leg to straighten the position of the foot and in some cases the lower leg.
  •  Prognosis is excellent if the condition is treated early.

Below is an x-ray image of Metarsus Adductus where the long bones of the foot, the metatarsals. that correlate to each toe are diverted at the level of the midfoot inward leading to a C-shaped foot.

 

Pics Below of Serial Casting for a Cavovarus foot that is reducible in a 5 week old.