Metatarsus adductus
Metatarsus adductus is a foot deformity in which the front part of the foot curves inwards while the heel usually stays in a normal position. Seen from the sole, the foot may look like a C or a half-moon. It is fairly common in newborns and in many cases improves during the first months of life with massage and stretching. If the deformity is rigid or does not improve with growth, it may need treatment with corrective casts.
- Typical age
- Babies
- Also known as
- C-shaped foot · Metatarsus varus
What is it?
Metatarsus adductus is a difference in the shape of the foot that is present from birth. The front part of the foot turns inwards, creating a characteristic curve, while the heel usually stays aligned. It can affect one or both feet and vary in flexibility.
It is one of the most common congenital foot deformities. Published estimates vary depending on the criteria used, but it is described in roughly one in every 1,000 newborns. Its cause is not fully understood and is linked to the baby’s position during pregnancy. In some children it may occur alongside other musculoskeletal conditions, so a full examination is important.
The key factor in deciding treatment is whether the foot can be gently corrected by hand. When the deformity is flexible, it usually improves during the first months of life with gentle stretching and massage. If the foot is rigid, the curve is marked or it does not improve, corrective casts may be needed.
Metatarsus adductus should not be confused with clubfoot (congenital talipes equinovarus). In clubfoot, as well as the forefoot turning inwards, there are changes in the heel and ankle that require specific treatment.
Signs parents may notice
The most common signs are:
- The front of the foot curves inwards: the foot looks like a C or a bean.
- Curved outer edge: instead of being fairly straight, it has a visible curve.
- Toes pointing towards the midline: the toes seem to point inwards.
- Difference between the feet: one may be more curved than the other.
- Difficulty gently correcting the position: in more rigid forms, the foot does not straighten easily.
In babies, this deformity is generally not painful.
When to see a specialist
An assessment by a paediatrician or paediatric orthopaedic specialist is advisable if:
- The curve is marked or seems to be increasing.
- The foot does not straighten gently when moved.
- The two feet are affected very differently.
- There is no improvement during the first months of life.
- There are other changes in the shape of the heel or the position of the ankle.
- The child has difficulty when starting to walk or a persistent walking problem.
When is it urgent?
Isolated metatarsus adductus is not usually an emergency. However, a very swollen foot with colour changes, coldness, severe pain or a deformity that appears suddenly needs urgent medical assessment, as these signs are not typical of uncomplicated congenital metatarsus adductus.
How is it diagnosed?
The diagnosis is usually made by physical examination, without the need for imaging.
The specialist looks at the foot from above and from the sole, assesses the curve of the outer edge and checks the position of the heel and ankle. They also determine whether the deformity is flexible, partly flexible or rigid, and whether it can be gently corrected by hand.
X-rays are not usually needed in babies with a typical deformity. They may be requested in older children, for rigid or atypical forms, or when there are diagnostic doubts and the bone structure needs to be studied.
Treatment
The choice of treatment depends mainly on the flexibility of the foot, the severity of the deformity and the child’s age.
Conservative treatment
Mild cases: massage and gentle mobilisation
When the foot has a mild curve and is flexible, massage and gentle mobilisation are usually recommended to encourage gradual correction. The specialist can show parents how to do them at home, without forcing the foot or causing pain. In many cases these measures go hand in hand with clinical follow-up, as the deformity can improve with massage during the first months of life.
Moderate cases: corrective casts
When the curve is more marked or does not improve enough with the initial measures, serial corrective casts may be used. These gradually change the position of the forefoot through regular cast changes, usually every one or two weeks, depending on progress and the specialist’s judgement.
Severe cases: casts and corrective devices
For more significant or rigid deformities, corrective casts may need to be combined with specific devices, such as Bebax shoes or corrective splints prescribed by the specialist. These devices help maintain or continue the correction achieved and must be adapted to the child’s age, the flexibility of the foot and the response to treatment.
The choice of device, how long it is used and whether it is combined with casts depend on each case and on the paediatric orthopaedic team’s protocol.
Surgical treatment
Surgery is exceptional and is reserved for persistent, rigid and functionally significant deformities that do not respond to conservative treatment. It is not usually indicated in babies.
In selected older children, the specialist may consider procedures to correct the alignment of the forefoot bones, such as osteotomies. The technique depends on age, the deformity and any bone changes present.
The operation requires general anaesthesia and may be followed by immobilisation in a cast. Hospital stay, weight-bearing and recovery time depend on the procedure performed.
Most children with metatarsus adductus do not need surgery.
Outlook and recovery
The outlook is usually good, especially in flexible cases.
- First months of life: many flexible deformities improve with massage and gentle mobilisation, so check-ups are scheduled according to how marked the curve is.
- Treatment with casts: usually lasts several weeks, with regular cast changes and check-ups to confirm the correction.
- After the casts are removed: the specialist assesses alignment and movement. In some cases further measures, such as Bebax shoes, may be recommended depending on progress.
- Starting to walk: most children with flexible forms walk normally.
- After surgery: recovery depends on the osteotomies performed and bone healing. Returning to school and sport is adapted to the immobilisation and medical advice.
Follow-up confirms that the deformity is improving and identifies the cases that need further treatment.
Frequently asked questions
Does metatarsus adductus correct itself?
Metatarsus adductus does not correct itself: mild cases need stretching. Rigid or persistent forms may need corrective casts.
Should I do exercises at home?
The specialist recommends them and shows you how to do them. The foot should never be forced or corrected with painful manoeuvres.
Can it affect the way my child walks?
Most children with flexible metatarsus adductus do well. Significant, persistent deformities need follow-up to assess their effect on function.
Will my child need special shoes or insoles?
Some children need Bebax shoes for a few months, depending on the protocol. Later in life, usually not.
Could surgery be needed?
Very rarely. Surgery is reserved for persistent, rigid cases that cause functional problems and do not respond to other methods.
This page is for general information and does not replace an assessment by a specialist. If you are worried about your child's foot, talk to their paediatrician or book an appointment.