{"id":6374,"date":"2021-12-27T12:46:37","date_gmt":"2021-12-27T12:46:37","guid":{"rendered":"https:\/\/isbipe.com\/2021\/12\/27\/metatarsus-adductus-in-children\/"},"modified":"2022-03-16T08:24:29","modified_gmt":"2022-03-16T08:24:29","slug":"metatarsus-adductus-in-children","status":"publish","type":"post","link":"https:\/\/isbipe.com\/en\/metatarsus-adductus-in-children\/","title":{"rendered":"METATARSUS ADDUCTUS IN CHILDREN"},"content":{"rendered":"[vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221; bg_image_animation=&#8221;none&#8221;][vc_column_text]\n<h2>My child has misshapen feet, is this normal?<\/h2>\n<p>&#8211; \u201cWhat is it?\u201d[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221; bg_image_animation=&#8221;none&#8221;][vc_column_text]\n<h2><b>What is it?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">This is a congenital<\/span><b>malformation<\/b> <span style=\"font-weight: 400;\">of the foot at the level of the<\/span> <b>tarsometatarsal joint<\/b><span style=\"font-weight: 400;\">(commonly known<\/span> <b>as the Lisfranc joint)<\/b><span style=\"font-weight: 400;\">that affects the soft tissues. It frequently occurs in newborns, in whom, if identified early and treated correctly, <\/span><b>it is resolved<\/b> <span style=\"font-weight: 400;\">in the majority of<\/span><b>cases without the need for surgery,<\/b><span style=\"font-weight: 400;\"> thus avoiding complications derived from this type of procedure that lengthen recovery times. it is resolved in the majority of cases without the need for surgery, thus avoiding complications derived from this type of procedure that lengthen recovery times. thus avoiding complications derived from this type of procedure that lengthen recovery times.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Metatarsus<\/span> <b>adductus<\/b><span style=\"font-weight: 400;\">is characterised by a disorder of forefoot alignment,<\/span><b>with variable degrees of adduction and supination,<\/b><span style=\"font-weight: 400;\">and is often associated<\/span> <b>with a slight<\/b> <b>rearfoot valgus<\/b>, <span style=\"font-weight: 400;\">a<\/span> <span style=\"font-weight: 400;\">differentiating<\/span>aspect of<b>clubfoot<\/b> <span style=\"font-weight: 400;\">(6-7).<\/span> <\/p>\n<h2><b><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-6198\" src=\"https:\/\/isbipe.com\/wp-content\/uploads\/2021\/11\/METATARSO-ADUCTO.jpg\" alt=\"METATARSUS ADDUCTUS\" width=\"638\" height=\"479\" srcset=\"https:\/\/isbipe.com\/wp-content\/uploads\/2021\/11\/METATARSO-ADUCTO.jpg 638w, https:\/\/isbipe.com\/wp-content\/uploads\/2021\/11\/METATARSO-ADUCTO-300x225.jpg 300w\" sizes=\"auto, (max-width: 638px) 100vw, 638px\" \/><\/b><\/h2>\n<h2><b>How is it diagnosed? <\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Diagnosis is fundamentally clinical<\/span>,<b>a good<\/b><span style=\"font-weight: 400;\">anamnesis and an appropriate<\/span> <b>physical<\/b><span style=\"font-weight: 400;\">examination<\/span> <b>are essential.<\/b><span style=\"font-weight: 400;\">. The contribution of complementary tests is less essential; <\/span><b>it is not necessary to carry out radiographic tests<\/b><span style=\"font-weight: 400;\"> on a regular basis in this type of pathology as they do not allow us to demonstrate forefoot mobility. However, it can be useful in advanced deformities to assess their severity and the effectiveness of treatment (8-9).<\/span><\/p>\n<h2><\/h2>\n<h2><b>How is it classified according to its severity?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">&#8220;In order to unify diagnostic and treatment criteria,<\/span> <b>as well as to<\/b> <span style=\"font-weight: 400;\">anticipate a prognosis&#8221;,<\/span> <b>C. Martos Mora et al.<\/b> <span style=\"font-weight: 400;\">propose a clinical-therapeutic classification<\/span><b>based on a retrospective study<\/b> <span style=\"font-weight: 400;\">of 87 patients with metatarsus adductus. They established three degrees of intensity of involvement: (5)<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>&#8211; Grade 1:<\/b> <span style=\"font-weight: 400;\">The deformity is<\/span> <b>mild<\/b>.<span style=\"font-weight: 400;\">. Forefoot adduction only, no inversion occurs. The foot can be abducted passively or by stimulation of the peroneal musculature.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">&#8211;<b>Grade 2<\/b>: <span style=\"font-weight: 400;\">The deformity<\/span> <b>is semi-rigid.<\/b><span style=\"font-weight: 400;\">. Adduction and inversion of the forefoot. There is some convexity of the outer edge, concavity of the inner edge, normal longitudinal arch and prominent and palpable fifth metatarsal.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\">&#8211; <b>Grade 3:<\/b> <span style=\"font-weight: 400;\">The deformity is more<\/span> <b>structured<\/b><span style=\"font-weight: 400;\">and acquires a &#8216;kidney-<\/span><b>shaped&#8217; form,<\/b><span style=\"font-weight: 400;\">with oblique grooves in the midfoot region and increased internal longitudinal arch. Unlike grades 1 and 2, passive correction of the forefoot is not possible at this stage. (2) (4-5) (2) (4-5)<\/span><\/li>\n<\/ul>\n<h2><\/h2>\n<h2><b>How is it treated?<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">In the mildest cases it resolves<\/span><b> spontaneously<\/b><span style=\"font-weight: 400;\"> and in the remaining cases, <\/span><b>if it is not corrected,<\/b><span style=\"font-weight: 400;\">the child will have <\/span><b>an uncomfortable gait<\/b><span style=\"font-weight: 400;\"> with internal deviation of the toes, thus favouring falls and, in the long term, the development<\/span><b> hallux valgus<\/b><span style=\"font-weight: 400;\"> due to <\/span><b>abnormal <\/b><span style=\"font-weight: 400;\">shoe fitting (6-7).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If it does not resolve spontaneously<\/span> i<b>n the first weeks of life,<\/b><span style=\"font-weight: 400;\">conservative treatment<\/span><b>is carried out,<\/b> <b>which includes:<\/b><span style=\"font-weight: 400;\">casts,<\/span> <span style=\"font-weight: 400;\">curved<\/span> <b>hypercorrection pads<\/b>, <span style=\"font-weight: 400;\">splints<\/span><b>or bandages.<\/b><span style=\"font-weight: 400;\">. The time of correction will depend on the severity, it is certain that the deformity must be <\/span><b>corrected before the child begins to walk.<\/b><span style=\"font-weight: 400;\">. If conservative treatment fails, or if the child is older than <\/span><b>4 years at<\/b><span style=\"font-weight: 400;\">the time of diagnosis<\/span>, <b>surgical correction should be proposed.<\/b><span style=\"font-weight: 400;\">. The preferred technique appears to <\/span><b>be an opening wedge osteotomy<\/b> <span style=\"font-weight: 400;\">of the first cuneiform using a<\/span> <a href=\"https:\/\/www.sciencedirect.com\/topics\/medicine-and-dentistry\/bone-graft\"><span style=\"font-weight: 400;\">bone graft<\/span><\/a>,<span style=\"font-weight: 400;\">in combination with a closing wedge osteotomy at the base of the second to fifth metatarsal (4) (10-11).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The<\/span> <b>general opinion is<\/b><span style=\"font-weight: 400;\">that serial<\/span> <b>cast<\/b> <span style=\"font-weight: 400;\">similar to those used in clubfoot are necessary, changing every 7 to 14 days for 1-3 months (12-13). In the experience of C. Martos-Mora et al (5), almost complete correction can be obtained <\/span><b>with<\/b><span style=\"font-weight: 400;\">daily bandaging<\/span> <b>in an average<\/b> <span style=\"font-weight: 400;\">of only 15 days<\/span>, <b>with<\/b><span style=\"font-weight: 400;\">a maintenance<\/span> <b>splint<\/b><span style=\"font-weight: 400;\">being used<\/span> <b>afterwards<\/b> <span style=\"font-weight: 400;\">to prevent the natural tendency of the foot to return to its original position. The advantages of bandaging and bracing would include, in addition to the shortened treatment period, the ease with which the child&#8217;s hygiene is carried out and the possibility of daily manipulation of the foot. In more structured cases, <\/span><b>it is<\/b><span style=\"font-weight: 400;\">proposed to maintain<\/span><b>correction<\/b> <span style=\"font-weight: 400;\">by wearing<\/span><b>straight-fitting boots<\/b> <span style=\"font-weight: 400;\">until 18 months<\/span><b>of age<\/b><span style=\"font-weight: 400;\">(14).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It should be noted that the method<\/span> <b>of functional corrective<\/b> <span style=\"font-weight: 400;\">bandaging is highly<\/span><b>effective <\/b> <span style=\"font-weight: 400;\">in the correction of metatarsus adductus foot. E. Utrilla Rodr\u00edguez et al carried out a retrospective study of <\/span><b>94 children born with this deformity and treated with this method, 68.1% achieved correction<\/b> <span style=\"font-weight: 400;\">(4). It is advisable in cases of flexible metatarsus adductus<\/span> <b>to monitor the posture<\/b> <span style=\"font-weight: 400;\">of children<\/span> <b>when sitting\/sleeping<\/b><span style=\"font-weight: 400;\"> as they can force the foot into a prolonged adduction position and this does not help correction. (15) (15)<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In summary, treatment will depend on<\/span> <b>the degree of involvement<\/b> <span style=\"font-weight: 400;\">being favourable when the foot is more flexible, within the first year. Sometimes the deformity is evident at birth, although in most cases, it is not detected until weeks or months later. Metatarsus adductus foot is a frequent reason for consultation associated with <\/span><b>considerable family distress<\/b>, <span style=\"font-weight: 400;\">and has a good prognosis.<\/span><b>Early diagnosis is essential for proper management and outcome.<\/b> <span style=\"font-weight: 400;\">(1-4)<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221; bg_image_animation=&#8221;none&#8221;][vc_text_separator title=&#8221;Bibliography&#8221; i_icon_fontawesome=&#8221;fa fa-book&#8221; i_background_style=&#8221;rounded-outline&#8221; color=&#8221;blue&#8221; add_icon=&#8221;true&#8221;][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; bg_color=&#8221;rgba(16,61,92,0.04)&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221; shape_type=&#8221;&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221; bg_image_animation=&#8221;none&#8221;][vc_column_text]\n<ol>\n<li>\n<h6>Fishco W, Ellis M, Cornwall M. Influence of a Metatarsus Adductus Foot Type on Plantar Pressures During Walking in Adults Using a Pedobarograph. The Journal of Foot and Ankle Surgery. 2015;54(3):449-453<\/h6>\n<\/li>\n<li>\n<h6>Williams C, James A, Tran T. Metatarsus adductus: Development of a non-surgical treatment pathway. Journal of Paediatrics and Child Health. 2013;49(9):E428-E433<\/h6>\n<\/li>\n<li>\n<h6>Winell JJ, Davidson RS. The foot and toes. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016: 674.<\/h6>\n<\/li>\n<li>\n<h6>Utrilla Rodr\u00edguez E, Guerrero Mart\u00ednez-Ca\u00f1avete M, Albornoz Cabello M, Munuera P. Tratamiento del pie metatarso aducto con el m\u00e9todo de vendajes funcionales correctores: estudio retrospectivo. Fisioterapia. 2016;38(5):229-234<\/h6>\n<\/li>\n<li>\n<h6>Martos-Mora C, Gentil-Fern\u00e1ndez J, Conejero-Casares J, Ramos-Moreno R. Metatarso aducto cong\u00e9nito: clasificaci\u00f3n cl\u00ednica y actitud terap\u00e9utica. Rehabilitaci\u00f3n. 2012;46(2):127-134<\/h6>\n<\/li>\n<li>\n<h6>G\u00f3mez MP, Garc\u00eda JM. Enfoque terap\u00e9utico del metatarso aducto cong\u00e9nito. Medicina de Rehabilitaci\u00f3n. 2000;13(3):29-31<\/h6>\n<\/li>\n<li>\n<h6>Esteo I, M\u00e9ndez LI, G\u00f3mez A, Mu\u00f1oz Y, D\u00edaz S, Devolx A, et al. Metatarso varo: \u00bfyesos o botas correctoras? Rev And Traum Ort. 2001;21(1):33-39<\/h6>\n<\/li>\n<li>\n<h6>Reina M, Lafuente G, Trujillo P, Ojeda A, Munuera PV, Dom\u00ednguez G. Metatarsus adductus: revisi\u00f3n y propuesta de tratamiento. Rev Esp Podol. 2006;17(1):18-23<\/h6>\n<\/li>\n<li>\n<h6>Turner WA, Merriman ML, editores. Habilidades cl\u00ednicas para el tratamiento del pie. Madrid: Elsevier; 2007<\/h6>\n<\/li>\n<li>\n<h6>JE Herzenberg, RD Burghardt. Metatarsus aductus resistente: ensayo prospectivo aleatorizado de yeso versus ortesis. J Orthop Sci , 19 ( 2014 ) , p\u00e1gs. 250 \u2013 256<\/h6>\n<\/li>\n<li>\n<h6>L. Feng , M. Sussman. Osteotom\u00eda cuneiforme medial combinada y osteotom\u00edas metatarsianas m\u00faltiples para la correcci\u00f3n del metatarso aducto persistente en ni\u00f1os. J Pediatr Orthop , 36 ( 2016 ) , p\u00e1gs. 730 \u2013 735<\/h6>\n<\/li>\n<li>\n<h6>Jackson JF, Stricker SJ. Pediatric foot notes: a review of common congenital foot deformities. International Pediatrics.2003;18:133-40. &#8212;&#8211;2<\/h6>\n<\/li>\n<li>\n<h6>Sass P, Hassan G. Lower extremity abnormalities in children. Am Fam Physician. 2003;68:461-8. &#8212;12<\/h6>\n<\/li>\n<li>\n<h6>Calzadilla Moreira V, Castillo Garc\u00eda I, Blanco Estrada J, Gonz\u00e1lez, Mart\u00ednez E. Desviaciones torsionales de los miembros inferiores en ni\u02dcnos y adolescentes. Rev Cubana Med Gen Integr.2002;5:355-61.<\/h6>\n<\/li>\n<li>\n<h6>Iglesias L, Vallejo B, Crespo S, Fuentes S. Mala postura al sentarse y deformidad del metatarsu aducto. J.Am. Podiatr. Med. Assoc. 2009;99:174-7.<\/h6>\n<\/li>\n<\/ol>\n[\/vc_column_text][\/vc_column][\/vc_row]\n","protected":false},"excerpt":{"rendered":"<p>[vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221;&#8230;<\/p>\n","protected":false},"author":3,"featured_media":6277,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[42],"tags":[],"class_list":{"0":"post-6374","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-scientific-posts"},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v18.5 (Yoast SEO v27.4) - 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