Metatarsus varus is a congenital condition where the bones in the front of the foot curve inward and can affect one or both feet. It can be caused by a persistent breech position or too little amniotic fluid. Treatment includes exercises, corrective shoes, casting, or surgery.
Metatarsus varus, which is also called metatarsus adductus, describes a congenital condition that causes the bones in the front of the foot, or forefoot, to curve inward. It can equally affect one or both feet. There are several potential reasons this condition could occur, and the severity of the problem usually cannot be estimated at birth. Instead, it is analyzed as children grow, and the severity of the curve is judged by how stiff the bony structure in the forefoot is becoming. Some children with this malformation outgrow it, while others may require interventions such as exercises, casting or surgery.
Conditions like metatarsus varus are often said to cause pigeon toe, a term that isn’t always used because it may have negative connotations. It is, however, a useful description for understanding the basic appearance of an affected foot, although the inward curvature should be understood as originating from the midfoot rather than the heel. Patients with metatarsus varus do not have heel bone malformations unless they have additional defects.
This congenital problem has been attributed to a few potential causes. It can occur in utero due to a persistent breech position of the fetus, which may not allow the forefoot bones to grow as straight as they should. Alternatively, too little amniotic fluid has been associated with higher rates of metatarsal varus. Some doctors believe that the curvature can occur any time a foot is squeezed into a position in the uterus where it cannot normally develop.
Newborns or slightly older children are fairly easy to diagnose with this birth defect due to the appearance of the foot. At first, it is difficult to predict what treatment, if any, is needed. As the child grows, the curved area sometimes stiffens, but in many children, the foot remains slack and metatarsus varus can self-correct. Doctors often recommend small exercises that parents can do with children to encourage straighter growth and shaping of the forefoot bones. Corrective shoes may also be recommended.
If stretching and therapeutic footwear don’t work, additional treatment may be considered when babies are between six and eight months old. The most recognized approach is to cast the child’s foot or feet to slowly deal with the unusual growth pattern. A series of casts, replaced every one to two weeks, gradually assist in straightening. In many cases, this treatment for metatarsal varus is effective. It also has the benefit of occurring at a time when most babies aren’t walking yet.
For a small percentage of children, casting doesn’t fully work and the problem may remain. In these cases, doctors may recommend surgical correction. Usually, surgery isn’t attempted until patients are at least four years old.
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