Metatarsus Adductus



  • Metatarsus adductus (MA) is rotational lower limb abnormality and a common pediatric foot deformity in which the metatarsals are deviated medially on the cuneiform bone.
  • MA is thought to be acquired in utero due to positioning and results in intoeing.
  • It is commonly referred to as being “pigeon toed.”
  • Classified as being flexible, semiflexible, or rigid
  • Flexible MA is the most common form of MA and resolves spontaneously in 95% of cases.
  • Cases of flexible MA that do not resolve spontaneously or cases of semiflexible/rigid MA may require serial casting or surgery.



  • MA occurs in 1 to 2 children per 1,000 live births.
  • Left foot affected more frequently than right
  • More common in males

Etiology and Pathophysiology

  • Etiology of MA is not yet fully understood; most commonly attributed to increased intrauterine pressure, supported by increased incidence in twin gestation
  • Small association with developmental dysplasia of the hip (DDH), approximately 2% of cases (1)[C]
  • Osseous abnormality or abnormal muscle attachments have also been proposed as possible etiologies.


  • No known genetic link in most cases of MA
  • One case study of MA in brothers with Aarskog-Scott syndrome
  • Higher incidence if sibling has MA

Risk Factors

  • First pregnancy
  • Twin gestation
  • Oligohydramnios

General Prevention

No known preventative measures for MA

Commonly Associated Conditions

  • There is a small association with DDH, likely related to intrauterine pressure.
  • One study found that 29–35% of patients undergoing surgery for hallux valgus deformity (bunion) have MA.
  • Hammertoe, medial tibial torsion, and torticollis have been associated with MA, but no long-term studies have confirmed this.

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