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A common referral to a pediatric orthopedist is for a foot deformity that may or may not be symptomatic. Conditions range from benign, self-resolving, perceived abnormalities involving the forefoot and toes, to more severe congenital and neuropathic deformities including clubfoot, congenital vertical talus, and cavus foot. Frequently, differentiation between a benign, resolving condition and a more severe pathologic deformity can be made by clinical examination and level of suspicion. A review of the common disorders, both benign and pathologic, will be presented to assist in the office evaluation of pediatric foot conditions.

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Metatarsus Adductus

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Medial deviation of the forefoot of an infant, termed metatarsus adductus, is one of the most common pediatric foot conditions (Fig. 213-1). Intrauterine positioning—medial rotation of the foot across the fetal torso—is the presumed cause of this positional deformity. The “deformity” is usually flexible and can be passively corrected, in which case no treatment is actually necessary. Rare cases with severe rigid deformity may require treatment.1

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Figure 213-1.
Graphic Jump LocationGraphic Jump Location

A: Dorsal view of bilateral metatarsus adductus. Note the medial deviation of all toes. (Reprinted with permission from Tachdjian’s Pediatric Orthopaedics, 4th Edition, edited by John A. Herring, Fig. 23-19A.)B: Plantar view. The lateral border of the foot is curved and “bean shaped.” (Reprinted with permission from Tachdjian’s Pediatric Orthopaedics, 4th Edition, edited by John A. Herring, Fig. 23-19B.)

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Clinically, the forefoot is medially deviated in relation to the hindfoot. When viewed from the plantar surface, the lateral border of the foot is curved and appears “bean shaped” (Fig. 213-1B). There may be additional medial deviation of the great toe and the appearance of a high arch.2 The deformity can be passively “corrected” if the examiner grasps the heel and maintains it in the neutral position, while abducting the forefoot (eFig. 213.1). Metatarsus adductus is almost always bilateral, although some children will demonstrate a “windswept” position of the feet, with one foot internally rotated with metatarsus adductus, and the opposite externally rotated by the intrauterine position.

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eFigure 213.1.
Graphic Jump Location

Passive correction by abducting the forefoot while maintaining hindfoot position with counterpressure on the lateral aspect of the heel. (Reprinted with permission from Tachdjian’s Pediatric Orthopaedics, 4th Edition, edited by John A. Herring, Fig. 23-19B.)

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Many children will present at walking age with intoeing. Metatarsus adductus is but one reason the foot progression angle can be deviated medially—the most common being internal tibial torsion (ITT). By observing the plantar surface of the foot (Fig. 213-1), the contribution to the intoeing coming from the forefoot can easily be appreciated and differentiated from ITT. ...

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