- 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
- First pregnancy
- Twin gestation
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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