Treating The Metatarsus Adductus Foot

Metatarsus adductus is a congenital deformity found in the pure transverse plane, which affects the alignment of the forefoot at the tarsometatarsal joint. 

As described by Rodríguez et al, the outer side edge of the foot is observed to be convex, with a lateral and dorsal prominence at the base of the fifth metatarsal and cuboid bone; there is also a lack of an equinus deformity which differentiates it from a clubfoot.

If left untreated, a metatarsus foot can progressively become severe in nature causing several alterations in gait and consequently, psychomotor disruption leading to an increased number of falls.

With varying degrees of misalignment and foot flexibility, treatment modalities for metatarsus adductus would have to be formulated in accordance with the patient’s condition to achieve successful outcomes and reduce unnecessary treatment costs.

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 According to Russell Volpe, from the Department of Applied Biomechanics at the Califromia School of Podiatric Medicine, the following clinical factors need to be considered before beginning treatment – the natural history of the deformity, potential compensations for the adducted forefoot, residual deformity as the child grows up and the presence of a hallux abductor valgus deformity.

The author recommends that patients exhibiting signs of a partially flexible or rigid metatarsus adductus deformity, need to be treated in the initial stages of the condition itself as spontaneous correction will not be achieved with normal development of the child. 

William Fishco, from The Podiatry Institute based in Georgia, encourages the use of functional foot orthoses to reduce chronic stress on the lateral metatarsals and cuboid region which is often vulnerable to lateral column overload, common in a metatarsus adductus foot.

Among some of the clinical conditions listed by him as being associated with such a foot type include large bunion deformities, non-traumatic osteoarthritis of the second and third tarsometatarsal joints, ankle instability and peroneal tendon pathologies.

An advantage of advocating MASS4D® foot orthotics as part of a comprehensive rehabilitative programme would be to address gait modifications triggered by the progression of metatarsus adductus – especially if the individual has a pes planus or pes cavus foot.

MASS4D® can also be used as a prophylactic device to improve symptomatology in a metatarsus adductus foot and to reduce the incidences of the clinical conditions mentioned above. This is achieved by the optimal distribution of weight in the foot and re-alignment of the musculoskeletal system.

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Related Links
Prevention and Assessment of Fall Risks in the Elderly
Peroneal Tendon Disorders
Orthotic Therapy for the Pes Cavus Foot

References:

1. Ultrilla-Rodríguez, E., Guerrero-Martínez-Cañavete, M. J., Albornoz-Cabello, M., Munuera-Martínez, P. V. (2016) Corrective Bandage for Conservative Treatment of Metatarsus Adductus: Retrospective Study. Physical Therapy: January 2016, Vol. 96, No. 1, pp. 47-52. DOI: 10.2522/ptj.20140443
2. Fishco, W. (2014) Managing The Tricky Metatarsus Adductus Foot. PodiatryToday. Retrieved from: http://www.podiatrytoday.com/
3. Volpe, R. G., Jay, R. M. (2008) Managing Pediatric Metatarsus Adductus: Should You Treat It? PodiatryToday: April 2008, Vol. 21, No. 4.

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