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Metatarsus Adductus

Pigeon toes, also called metatarsus varus, metatarsus adductus, in-toe gait, intoeing or false clubfoot, is a condition which causes the toes to point inward when walking. It is most common in infants and children under two years of age and, when not the result of simple muscle weakness, normally arises from one of three underlying conditions, a twisted shin bone, an excessive anteversion (femoral head is more than 15 degrees from the angle of torsion) resulting in the twisting of the thigh bone when the front part of a person's foot is turned in.
In MTA, the forefoot is turned inwards, while the hindfoot (or heel) is normal. If the hindfoot is involved, it becomes a more serious problem. If the forefoot adductus or varus is associated with hindfoot valgus, it is called a skew foot. If the forefoot adductus is associated with hindfoot varus and ankle equinus where the foot points downwards, the problem is a clubfoot.

Symptoms of a Pigeon Toe

The front of the foot is bent or angled in toward the middle of the foot. The back of the foot and the ankles are normal. About half of pigeon toed children have the problem in both feet.

metatarsal

Causes of MTA

MTA is very common in the newborn, and is usually due to the feet being "packed" in the womb in that position. The forefoot adduction at this stage is very flexible, and with freedom of movement, this postural condition of MTA often improves over the next 6 to 12 weeks. In about 15% of cases, the adducted position of the forefoot does not improve. In fact, the deformity becomes less flexible. A crease starts to appear on the medial border of the foot and a bony "bump" on the lateral border of the foot, right at the junction of the forefoot and hindfoot. This is the classic MTA that may require treatment.

Treatment

Treatment depends on how rigid the foot is when the doctor tries to straighten it. If the foot is very flexible and easy to straighten or move in the other direction, no treatment may be needed. You child will be followed closely for a period of time. In most children, the problem corrects itself as they use their feet normally. They don't need any further treatment.
If the problem does not improve or your child's foot is not flexible enough, other treatments will be tried:

  • Stretching exercises may be needed. These are done if the foot can be easily moved into a normal position. The family will be taught how to do these exercises at home.
  • Your child may need to wear a splint or special shoes, called reverse-last shoes, for most of the day. These shoes hold the foot in the correct position.
  • Rarely, your child will need to have a cast on the foot and leg. Casts work best if they are put on before your child is 8 months old. The casts will probably be changed every 1 - 2 weeks.
  • Surgery may be needed, but not very often. Most of the time, your doctor will delay surgery until your child is between 4 and 6 years old.

A pediatric orthopaedic surgeon should be involved in treating more severe deformities.

Expectations (prognosis)

The outcome is almost always excellent. Nearly all patients eventually have a normal looking and working foot.

Complications

A small number of infants with metatarsus adductus may have developmental dislocation of the hip.

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