Skip to main content

Pediatric Metatarsus Adductus and Cavovarus Foot

  • Chapter
  • First Online:
Foot and Ankle Disorders
  • 2136 Accesses

Abstract

Metatarsus adductus is a common congenital deformity of the child’s midfoot that rarely causes disability or requires surgical intervention. If the metatarsus adductus is rigid or associated with an underlying condition, serial casting or bracing may be of benefit. The cavovarus foot is more challenging to treat. The deformity is typically progressive. A causative diagnosis must be sought. It consists of concurrent deformities generally resulting from muscle imbalance: high medial arch with plantarflexion of the first ray and a varus hindfoot. Successful surgical correction is based on principles of deformity and soft tissue balancing.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Mosca V, Bouchard M. Chapter 28: The foot. In: Weinstein SL, Flynn JM, editors. Lovell and Winter’s pediatric orthopedics. 8th ed. Philadelphia: Lippincott Williams and Wilkins; 2020. p. 1431–4.

    Google Scholar 

  2. Wynne-Davies R. Family studies and the cause of congenital club foot. Talipes equinovarus, talipes calcaneo-valgus and metatarsus varus. J Bone Joint Surg Br. 1964;46:445–63.

    Article  CAS  PubMed  Google Scholar 

  3. Hunziker UA, Largo RH, Duc G. Neonatal metatarsus adductus, joint mobility, axis, and rotation of the lower extremity in preterm and term children 0–5 years of age. Eur J Pediatr. 1988;148:19–23.

    Article  CAS  PubMed  Google Scholar 

  4. Kite JH. Congenital metatarsus varus. J Bone Joint Surg Am. 1967;49:388–97.

    Article  CAS  PubMed  Google Scholar 

  5. Kumar SJ, MacEwen GD. The incidence of hip dysplasia with metatarsus adductus. Clin Orthop Relat Res. 1982;164:234–5.

    Google Scholar 

  6. Gruber MA, Lozano JA. Metatarsus varus and developmental dysplasia of the hip: is there a relationship? Orthop Trans. 1991;15:336.

    Google Scholar 

  7. Kollmer CE, Betz RR, Clancy M, et al. Relationship of congenital hip and foot deformities: a national Shriner’s Hospital survey. Orthop Trans. 1991;15:96.

    Google Scholar 

  8. Rushforth GF. The natural history of hooked forefoot. J Bone Joint Surg Br. 1978;60-B:530–2.

    Article  CAS  PubMed  Google Scholar 

  9. Wynne-Davies R, Littlejohn A, Gormley J. Aetiology and interrelationship of some common skeletal deformities. (Talipes equinovarus and calcaneovalgus, metatarsus varus, congenital dislocation of the hip, and infantile idiopathic scoliosis). J Med Genet. 1982;19:321–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Morcuende JA, Ponseti IV. Congenital metatarsus adductus in early human fetal development: a histologic study. Clin Orthop Relat Res. 1996;333:261–6.

    Article  Google Scholar 

  11. Browne RS, Paton DF. Anomalous insertion of the tibialis posterior tendon in congenital metatarsus varus. J Bone Joint Surg Br. 1979;61:74–6.

    Article  CAS  PubMed  Google Scholar 

  12. Asirvatham R, Stevens PM. Idiopathic forefoot-adduction deformity: medial capsulotomy and abductor hallucis lengthening for resistant and severe deformities. J Pediatr Orthop. 1997;17:496–500.

    CAS  PubMed  Google Scholar 

  13. Mitchell GP. Abductor hallucis release in congenital metatarsus varus. Int Orthop. 1980;3(4):299–304. https://doi.org/10.1007/BF00266025. PMID: 7399770

    Article  CAS  PubMed  Google Scholar 

  14. Mosca VS. Principles and management of pediatric foot and ankle deformities and malformations. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2014. p. 21, 26, 32–33, 43, 45, 68–69, 145–160, 176–177, 226–235.

    Google Scholar 

  15. Cappello T, Mosca VS. Metatarsus adductus and skewfoot. Foot Ankle Clin. 1998;3:683–700.

    Google Scholar 

  16. Ponseti IV, Becker JR. Congenital metatarsus adductus: the results of treatment. J Bone Joint Surg Am. 1966;48:702.

    Article  CAS  PubMed  Google Scholar 

  17. Farsetti P, Weinstein SL, Ponseti IV. The long-term functional and radiographic outcomes of untreated and non-operatively treated metatarsus adductus. J Bone Joint Surg Am. 1994;76:257–65.

    Article  CAS  PubMed  Google Scholar 

  18. Bleck EE. Metatarsus adductus: classification and relationship to outcomes of treatment. J Pediatr Orthop. 1983;3:2–9.

    Article  CAS  PubMed  Google Scholar 

  19. Bleck EE. Developmental orthopaedics. III. Toddlers. Dev Med Child Neurol. 1982;24:533.

    CAS  PubMed  Google Scholar 

  20. Smith JT, Bleck EE, Gamble JG, et al. Simple method of documenting metatarsus adductus. J Pediatr Orthop. 1991;11:679–80.

    Article  CAS  PubMed  Google Scholar 

  21. Ghali NN, Abberton MJ, Silk FF. The management of metatarsus adductus et supinatus. J Bone Joint Surg Br. 1984;66:376–80.

    Article  CAS  PubMed  Google Scholar 

  22. Williams CM, James AM, Tran T. Metatarsus adductus: development of a non-surgical treatment pathway. J Paediatr Child Health. 2013;49(9):E428–33. https://doi.org/10.1111/jpc.12219. Epub 2013 May 6. PMID: 23647850.

    Article  PubMed  Google Scholar 

  23. Eamsobhana P, Rojjananukulpong K, Ariyawatkul T, Chotigavanichaya C, Kaewpornsawan K. Does the parental stretching programs improve metatarsus adductus in newborns? J Orthop Surg (Hong Kong). 2017;25(1):2309499017690320. https://doi.org/10.1177/2309499017690320. PMID: 28215117.

  24. Berg EE. A reappraisal of metatarsus adductus and skewfoot. J Bone Joint Surg Am. 1986;68:1185–96.

    Article  CAS  PubMed  Google Scholar 

  25. Katz K, David R, Soudry M. Below-knee plaster cast for the treatment of metatarsus adductus. J Pediatr Orthop. 1999;19(1):49–50. PMID: 9890286.

    CAS  PubMed  Google Scholar 

  26. McCauley J Jr, Lusskin R, Bromley J. Recurrence in congenital metatarsus varus. J Bone Joint Surg Am. 1964;46:525–32.

    Article  PubMed  Google Scholar 

  27. Herzenberg JE, Burghardt RD. Resistant metatarsus adductus: prospective randomized trial of casting versus orthosis. J Orthop Sci. 2014;19(2):250–6. https://doi.org/10.1007/s00776-013-0498-7. Epub 2013 Nov 19. PMID: 24248551.

    Article  PubMed  Google Scholar 

  28. Stark JG, Johanson JE, Winter RB. The Heyman-Herndon tarsometatarsal capsulotomy for metatarsus adductus: results in 48 feet. J Pediatr Orthop. 1987;7:305–10.

    Article  CAS  PubMed  Google Scholar 

  29. McHale KA, Lenhart MK. Treatment of residual clubfoot deformity—the “bean-shaped” foot—by opening wedge medial cuneiform osteotomy and closing wedge cuboid osteotomy. Clinical review and cadaver correlations. J Pediatr Orthop. 1991;11:374–81.

    Article  CAS  PubMed  Google Scholar 

  30. Anderson DA, Schoenecker PL, Blair VPI. Combined lateral column shortening and medial column lengthening in the treatment of severe forefoot adductus. Orthop Trans. 1991;15:768.

    Google Scholar 

  31. Conklin MJ, Kling TF. Open-wedge osteotomies of the first cuneiform for metatarsus adductus. Orthop Trans. 1991;106.

    Google Scholar 

  32. Feng L, Sussman M. Combined medial cuneiform osteotomy and multiple metatarsal osteotomies for correction of persistent metatarsus adductus in children. J Pediatr Orthop. 2016;36(7):730–5. https://doi.org/10.1097/BPO.0000000000000559. PMID: 26057072.

    Article  PubMed  Google Scholar 

  33. Holden D, Siff S, Butler J, et al. Shortening of the first metatarsal as a complication of metatarsal osteotomies. J Bone Joint Surg Am. 1984;66:582–7.

    Article  CAS  PubMed  Google Scholar 

  34. Knörr J, Soldado F, Pham TT, Torres A, Cahuzac JP, de Gauzy JS. Percutaneous correction of persistent severe metatarsus adductus in children. J Pediatr Orthop. 2014;34(4):447–52. https://doi.org/10.1097/BPO.0000000000000122. PMID: 24276227.

    Article  PubMed  Google Scholar 

  35. Kim BS. Reconstruction of cavus foot: a review. Open Orthop J. 2017;11:651–9. https://doi.org/10.2174/1874325001711010651.

    Article  PubMed  PubMed Central  Google Scholar 

  36. VanderHave KL, Hensinger RN, King BW. Flexible cavovarus foot in children and adolescents. Foot Ankle Clinic N Am. 2013;18(4):715–26.

    Article  Google Scholar 

  37. Schwend R, Drennan J. Cavus foot deformity in children. J Am Acad Orthop Surg. 2003;11(3):201–11.

    Article  PubMed  Google Scholar 

  38. Dwyer FC. The present status of the problem of pes cavus. Clin Orthop. 1975;106:254–75.

    Article  Google Scholar 

  39. Lee MC, Sucato DJ. Pediatric issues with cavovarus foot deformities. Foot Ankle Clin. 2008;13(2):199–219, v. https://doi.org/10.1016/j.fcl.2008.01.002.

    Article  PubMed  Google Scholar 

  40. Alexander IJ, Johnson KA. Assessment and management of pes cavus in Charcot-Marie-Tooth disease. Clin Orthop Relat Res. 1989;246:273–81.

    Article  Google Scholar 

  41. DeVries JG, McAlister JE. Corrective osteotomies used in cavus reconstruction. Clin Podiatr Med Surg. 2015;32(3):375–87. https://doi.org/10.1016/j.cpm.2015.03.003.

    Article  PubMed  Google Scholar 

  42. Dreher T, Beckmann NA, Wenz W. Surgical treatment of severe cavovarus foot deformity in Charcot-Marie-Tooth disease. JBJS Essent Surg Tech. 2015;5(2):e11. https://doi.org/10.2106/JBJS.ST.N.00005.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Bouchard M. Assessment and Management of the Pediatric Cavovarus Foot. Instruct Course Lect. 2020;69:321–90.

    Google Scholar 

  44. Krause F, Seidel A. Malalignment and lateral ankle instability: causes of failure from the varus tibia to the cavovarus foot. Foot Ankle Clin. 2018;23(4):593–603. https://doi.org/10.1016/j.fcl.2018.07.005.

    Article  PubMed  Google Scholar 

  45. Coleman SS, Chestnut WJ. A simple test for hindfoot flexibility in the cavovarus foot. Clin Orthop Relat Res. 1977;123:60–2.

    Google Scholar 

  46. Barton T, Winson I. Joint sparing correction of cavovarus feet in Charcot-Marie-Tooth disease: what are the limits? Foot Ankle Clin. 2013;18(4):673–88. https://doi.org/10.1016/j.fcl.2013.08.008.

    Article  PubMed  Google Scholar 

  47. Kaplan JRM, Aiyer AA, Cerrato RA, Jeng CL, Campbell JT. Operative treatment of the cavovarus foot. Foot Ankle Int. 2018;39(11):1370–82.

    Article  PubMed  Google Scholar 

  48. Wicart P. Cavus foot, from neonates to adolescents. Orthop Traumatol Surg Res. 2012;98(7):813–28. https://doi.org/10.1016/j.otsr.2012.09.003.

    Article  CAS  PubMed  Google Scholar 

  49. d’Astorg H, Rampal V, Seringe R, Glorion C, Wicart P. Is non-operative management of childhood neurologic cavovarus foot effective? Orthop Traumatol Surg Res. 2016;102(8):1087–91.

    Article  PubMed  Google Scholar 

  50. Burns J, Scheinberg A, Ryan MM. Randomized trial of botulinum toxin to prevent pes cavus progression in pediatric Charcot-Marie-Tooth disease type 1A. Muscle Nerve. 2010;42:262–7.

    Article  PubMed  Google Scholar 

  51. Weiner DS, Jones K, Jonah D, Dicintio MS. Management of the rigid cavus foot in children and adolescents. Foot Ankle Clin. 2013;18(4):727–41. https://doi.org/10.1016/j.fcl.2013.08.007.

    Article  PubMed  Google Scholar 

  52. Mubarak SJ, Van Valin SE. Osteotomies of the foot for cavus deformities in children. J Pediatr Orthop. 2009;29:294–9.

    Article  PubMed  Google Scholar 

  53. Simon A-L, Seringe R, Badina A, Khouri N, Glorion C, Wicart P. Long term results of the revisited Meary closing wedge tarsectomy for the treatment of the fixed cavavarus foot in adolescent with Charcot-Marie-Tooth disease. Foot Ankle Surg. 2018;15: pii: S1268-7731(18)34087-9.

    Google Scholar 

  54. Uglow MG. Percutaneous pediatric foot and ankle surgery. Foot Ankle Clin. 2016;21(3):577–94. https://doi.org/10.1016/j.fcl.2016.04.005. Epub 2016 Jun 29. PMID: 27524707.

    Article  PubMed  Google Scholar 

  55. Mourkus H, Prem H. Double calcaneal osteotomy with minimally invasive surgery for the treatment of severe flexible flatfeet. Int Orthop. 2018;42(9):2123–9. https://doi.org/10.1007/s00264-018-3910-2. Epub 2018 Mar 26. PMID: 29582117.

    Article  PubMed  Google Scholar 

  56. Gutteck N, Zeh A, Wohlrab D, Delank KS. Comparative results of percutaneous calcaneal osteotomy in correction of hindfoot deformities. Foot Ankle Int. 2019;40(3):276–81. https://doi.org/10.1177/1071100718809449. Epub 2018 Nov 9. PMID: 30413133.

    Article  PubMed  Google Scholar 

  57. Pfeffer GB, Michalski MP, Basak T, Giaconi JC. Use of 3D prints to compare the efficacy of three different calcaneal osteotomies for the correction of heel varus. Foot Ankle Int. 2018;39(5):591–7.

    Article  PubMed  Google Scholar 

  58. Turner JW, Cooper RR. Anterior transfer of the tibialis posterior through the interosseous membrane. Clin Orthop Relat Res. 1972;1(2):41–9.

    Google Scholar 

  59. Aydin A, Topal M, Tuncer K, Canbek U, Yildiz V, Kose M. Extramembranous transfer of the tibialis posterior for the treatment of drop foot deformity in children. Arch Iran Med. 2013;16(11):647–51.

    PubMed  Google Scholar 

  60. Grill F, Franke J. The Ilizarov distractor for the correction of relapsed or neglected clubfoot. J Bone Joint Surg Br. 1987;69:593–7.

    Article  CAS  PubMed  Google Scholar 

  61. Ferreira RC, Costo MT, Frizzo GG, et al. Correction of neglected clubfoot using the Ilizarov external fixator. Foot Ankle Int. 2006;27:266–73.

    Article  PubMed  Google Scholar 

  62. Mubarak SJ, Dimeglio A. Navicular excision and cuboid closing wedge for severe cavovarus foot deformities: a salvage procedure. J Pediatr Orthop. 2011;31:551–6.

    Article  PubMed  Google Scholar 

  63. Shariff R, Myerson MS, Palmanovich E. Resection of the fifth metatarsal base in the severe rigid cavovarus foot. Foot Ankle Int. 2014;35(6):558–65.

    Article  PubMed  Google Scholar 

  64. Penny JN. The neglected clubfoot. Tech Orthop. 2005;20(2):153–66.

    Article  Google Scholar 

  65. Saltzman CL, Fehrle MJ, Cooper RR, et al. Triple arthrodesis: twenty-five and forty-four-year average follow-up of the same patients. J Bone Joint Surg Am. 1999;81-A(10):1391Y1402.

    Google Scholar 

  66. Aarts CAM, Heesterbeek PJC, Jaspers PEM, Stegeman M, Louwerens JWK. Does osteoarthritis of the ankle joint progress after triple arthrodesis? A midterm prospective outcome study. Foot Ankle Surg. 2016;22:265–9.

    Article  PubMed  Google Scholar 

  67. Wukilch DK, Bowen JR. A long-term study of triple arthrodesis for correction of pes cavovarus in Charcot-Marie-Tooth disease. J Pediatr Orthop. 1989;9:433–7.

    Google Scholar 

  68. Wetmore RS, Drennan JC. Long-term results of triple arthrodesis in Charcot-Marie-Tooth disease. J Bone Joint Surg Am. 1989;71:417–22.

    Article  CAS  PubMed  Google Scholar 

  69. Mann DC, Hsu JD. Triple arthrodesis in the treatment of fixed cavovarus deformity in adolescent patients with Charcot-Marie-Tooth disease. Foot Ankle. 1992;13(1):1–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Maryse Bouchard .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bouchard, M. (2022). Pediatric Metatarsus Adductus and Cavovarus Foot. In: Wagner Hitschfeld, E., Wagner Hitschfeld, P. (eds) Foot and Ankle Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-95738-4_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-95738-4_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-95737-7

  • Online ISBN: 978-3-030-95738-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics