Skip to Main Content

++

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.

++

Metatarsus Adductus

++

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

++
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.)

++

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.

++
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.)

++

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 ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPediatrics

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.