Metatarsus adductus

foot

1. Metatarsus adductus By Dr Alamzeb Khan Swati

2. Adduction of forefoot in relation to midfoot and hindfoot.

3. CAUSES Thought to be caused by infant position in the womb Risk factors include Late pregnancy, first pregnancy,twin pregnancy and oligohydramnios . Equal incidence in boys n girls. 50% are bilateral. 1-5% have associated DDH or acetabular dysplasia.

4. Classified into mild,moderate and severe forms. mild form forefoot can be clinically adducted to midline of foot n beyond In moderate form forefoot adduction to midline is possible In rigid metatarsus the foot can not be abducted at all.there may be transverse crease on medial side of foot and increased web space between great toe and second toe.

5. Bleck classification by heel bisector method. Normal  - heel bisector line through 2nd and 3rd toe webspace mild - heel bisector line through 3rd toe moderate - heel bisector through 3rd and 4th toe webspace severe - heel bisector through 4th and 5th toe webspace

6. Metatarsus adductus can be seen as residual deformity of surgically or non surgically treated club foot. It can be rigid ,indicating fixed position of foot or dynamic ,caused by imbalance of anterior tibial tendon during gait.

7. Treatment In general,mild form resolves without treatment. Moderate or severe forms is initially treated by serial stretching and casting for 6-12 weeks,or until foot is clinically flexible.

8. Non operative treatment Flexible deformities that can  actively  be corrected to midline usually  no treatment required. Flexible deformities that can  passively  be corrected to midline Serial stretching by parents at home. Rigid deformity with medial crease Serial casting with the goal of obtaining a straight lateral border of foot.

9. Operative treatment Indicated only for deformities not corrected by conservative treatment. Also indicated for patients with painful foot,unacceptable cosmetic appearance of foot and difficulty in wearing shoes.

10. For children 2-4 years tarsometatarsal capsulotomies(Heyman,Herndon and Strong) For >4 years old children multiple metatarsal osteotomies(Berman and Gartland),medial cuneiform,lateral cuneiform and lateral cuboid double osteotomy.

11. Berman and Gartland osteotomy involves approach to all five metatarsal heads through dorsal incision. A dome shaped osteotomy is performed in each metatarsal and fixed with Steinman pin. Before closure check AP talus-fist metatasal angle,shuld be correcred 0-10 degrees.

12. Cuneiform and cuboid osteotomies Cuneiform osteotomy is performed leaving insertion of tibialis anterior intact. Wedge shaped cuboid osteotomy is performed. Fix bones with K wires.