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Resistant metatarsus adductus: prospective randomized trial of casting versus orthosis

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Metatarsus adductus is a common pediatric foot deformity related to intrauterine molding. It is usually a mild deformity that responds well to simple observation or minimal treatment with a home program of stretching. Resistant cases may need a more aggressive approach such as serial casting or special bracing to avoid the need for surgical intervention. We compared clinical outcomes using serial casting with orthoses for resistant metatarsus adductus.

Methods

We prospectively treated 27 infants (43 feet) between the ages 3 and 9 months who failed home stretching treatment. Patients were randomized to either serial plaster casting or Bebax orthoses. Footprints and simulated weight-bearing anteroposterior and lateral view radiographs were made at entry and follow-up.

Results

There was no statistical difference between casting and Bebax for the following parameters: age at study entry, length of treatment, number of clinic visits, follow-up, and follow-up maintenance treatments. Both groups showed improvement in footprint and radiographic measurements post-treatment, without worsening of heel valgus. The Bebax group had greater improvement in the footprint heel bisector measurement than the casting group. The Bebax treatment requires more active parental cooperation. A simulated cost analysis of materials and office visit charges, however, revealed that Bebax treatment was significantly less expensive, about half the cost of casting.

Conclusion

Because of the cost savings and virtually identical clinical results, we recommend the Bebax orthosis for resistant metatarsus in pre-walking infants with parents who are compliant. Other considerations include specific insurance plans, which may pay for casts but not orthoses.

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Acknowledgments

This study was funded in part by Camp International, Jackson, MI, USA, and the Department of Orthopedics at the University of Michigan, Ann Arbor, MI, USA.

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Authors and Affiliations

  1. International Center for Limb Lengthening, The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA

    John E. Herzenberg

  2. Endoklinik Hamburg, Holstenstraße 2, 22767, Hamburg, Germany

    Rolf D. Burghardt

Authors
  1. John E. Herzenberg
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  2. Rolf D. Burghardt
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Correspondence to Rolf D. Burghardt.

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Herzenberg, J.E., Burghardt, R.D. Resistant metatarsus adductus: prospective randomized trial of casting versus orthosis. J Orthop Sci 19, 250–256 (2014). https://doi.org/10.1007/s00776-013-0498-7

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  • DOI: https://doi.org/10.1007/s00776-013-0498-7

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