Universal neonatal foot orthotics—a novel treatment of infantile metatarsus adductus

Abstract

Approximately one in 100 babies has metatarsus adductus) MTA(. Although most deformities may resolve spontaneously, moderate and severe deformities might cause future discomfort and are therefore often treated. Common treatment alternatives include stretching, serial casting, and orthoses. Surgery is reserved for severe cases that are unresponsive to conservative management. The purpose of this study was to present our experience with a novel orthosis designed to correct and maintain correction of MTA in infants. Seventy-three children between the ages of 4 and 11.5 months with moderate to severe MTA were treated using the Universal Neonatal Foot Orthosis (UNFO). Treatment was started in cases of rigid deformity when the child was first seen in the clinic, or after the age of 5 months in children with moderate or severe but flexible deformity that failed to improve spontaneously. The orthosis was applied for 23 h daily. Weaning was started after a complete correction of the deformity was achieved. Follow-up was continued at least until walking age. Results were assessed utilizing the heel bisector line (HBL) as a measure of foot deformity before, during, and after treatment completion, and at the end of follow-up. Seventy-one patients (114 feet (were followed from the time of diagnosis to at least walking age. There were 102 severe (HBL at, or lateral to, the 4^TH toe) and 12 moderate MTA (HBL between 3^rd and 4^th toes). Average age at the beginning of treatment was 6.58 months (range 4–11.5). Of the study population, 56 patients (98 feet) improved significantly by the end of the follow-up. In 11 children (11 feet), no change was noted, and in 3 children (3 feet), worsening of the deformity was observed at the end of follow-up. In one child who discontinued treatment after 6 weeks, there was no change in one foot and worsening in the other. Minor side effects were observed in 11 patients, all resolved uneventfully.

Conclusion: UNFO is an effective treatment for moderate and severe MTA in children younger than10 months, with only infrequent minor side effects.

What is Known: • Debate exists as to which patient warrants treatment since spontaneous improvement is the rule. However, some deformities persist to adulthood and may be esthetically unpleasing. • Treatment modalities available vary from benign neglect, special shoe ware that are either static or need special tools, and knowledge to adjust or casting by an orthopedic surgeon What is New: • This is a description of the results of treatment with a new orthotics which may be applied by pediatricians to treat this very common neonatal deformity. The orthotics provides an excellent, short duration solution, easy for the baby and caregiver with results comparable to those of more elaborate orthotics and casting • The use of digital pictures to assess forefoot adduction deformity severity instead of radiographs is a reliable measurement method.