What is metatarsus adductus in children?

Metatarsus adductus (MTA) is a common foot deformity noted at birth. It causes the front half of the child’s foot (forefoot) to turn inward. The foot may still be flexible. This means it can be straightened to a degree by hand. Or it may be nonflexible. This means it can’t be straightened by hand.

What causes metatarsus adductus in a child?

The cause of MTA is not known. It is more common in firstborn children.

What are the symptoms of metatarsus adductus in a child?

A child with MTA has a forefoot that turns inward. They may walk or run with the feet turned inward instead of straight. This is commonly called in-toeing or being "pigeon-toed." They may also have a high arch and a wide gap between the big toe and the second toe.

How is metatarsus adductus diagnosed in a child?

Your child’s healthcare provider can diagnose MTA with an exam. During the exam, the provider may ask about your child’s birth history and if other family members had the condition.

Your child’s healthcare provider may use passive manipulation to see if your child has flexible or nonflexible MTA. This method puts gentle pressure on the forefoot to align it with the heel. If the forefoot can be aligned, your child has flexible MTA. If it is hard to align, your child has a nonflexible, or stiff, foot.

Your child may also need X-rays. This is often done if the case is severe or the foot is nonflexible.

How is metatarsus adductus treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how bad the condition is.

Most children with MTA don’t need treatment. The foot often straightens out as the child grows. If treatment is needed, it depends on how easily the affected foot bends. The goal of treatment is to straighten the position of the forefoot and heel. Treatment may include:

• Observation. Children with a flexible forefoot will likely improve without any treatment.

• Stretching or passive manipulation exercises. Your child’s healthcare provider may teach you how to do this method on your child’s feet.

• Casts. In rare cases, your child's foot may not respond to a stretching program. Long leg casts may be used. Casts help stretch the soft tissues of the forefoot. Your child’s healthcare provider will change them every 1 to 2 weeks.

• Straight last shoes. If your child’s foot responds to casting, straight last shoes may be used to help hold the forefoot in place. These shoes are made without a curve in the bottom of them.

• Surgery. Your child may need surgery if they have very rigid or severe MTA. Surgery can release the forefoot joints. After surgery, casts are usually put on to hold the forefoot in place as it heals.

What are possible complications of metatarsus adductus in a child?

Babies born with MTA may have a higher risk for developmental dysplasia of the hip. This is a condition of the hip joint. It’s when the top of the thighbone (femur) slips in and out of its socket. This happens because the socket is too shallow to keep the joint intact.

Key points about metatarsus adductus in children

• Metatarsus adductus is a common foot deformity. It causes the front half of a child’s foot to turn inward.

• This health problem is usually noted at birth. The cause is not known.

• The foot may be flexible or inflexible. The degree of flexibility and severity of the condition help decide treatment.

• Most children with the condition don’t need treatment. The foot often straightens out as the child grows.

• If treatment is needed, it may involve stretching, casting, or surgery.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.