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I had a woman bring in her 5 month old son because she was concerned his feet were 'turning in' and the maternal nurse thought it would be best to get a podiatrist's opinion. An Ax showed FF adduction, convex lateral border, prominant styloid, big gap b/w 1st and 2nd toes and normal AJ ROM. L>>R.
My prelim diagnosis is semi rigid met adductus. I have read literature claiming most kids grow out of it but I also read that the deformity can become increasingly resistant to conservative Tx if not treated in the first few months of life.
Plaster/serial casting is mentioned quite frequently and I was wondering who would perform that? We certainly weren't taught that at uni. Otherwise, is stretching and manipiulation the only way to go? He is not wearing shoes yet
Serial casting is certainly the required treatment, and 5 months old is the perfect age to do so. Once they start walking the horse has bolted and you are dreaming if you can cast out the deformity at this time.
If you are not experienced at doing so, refer to a local colleague who can do met adductus casting, and take the opportunity go along and learn the technique from them. *Do Not* attempt without prior exerience or you may create a skew foot or similar.
Work through your local podiatry network to find the right person for the job, and take it as an opportunity to invite yourself along to learn a new skill.
I was lucky enough to have a patient with Met Adductus when I was at Uni. Plenty of help with learning the serial casting technique which needs accuracy. There were also some mobilisation exercises which we tried for a few weeeks before resorting to casting. Unfortunately he was at the 24 months old limit that literature suggests that treatment will fail. I could see no significant change after treatment and the child did not like having the cast on. I agree with LL to get some help and make sure they have addequate mobility that treatment will be successful.
Metatarsus adductus
Linear Mode
