Metatarsus adductus (bung feet) & intoeing (pigeon toes)

What is metatarsus adductus and in-toeing, how can you detect it and how can it be fixed?

I feel so blessed that Misaki is generally a very healthy baby. She had a few musculoskeletal issues in the early days which kept us busy. I think she may have inherited my long legs as being couped up in my womb she also inherited my metatarsus adductus and her paternal auntie's hip dysplasia. See our blog on Hip Dysplasia.

Metatarsus adductus is not pigeon toes (a lay term for feet turning inward which can be due to feet, shins or hips turning inwards) and not clubbed foot (which is an extreme form of the foot and ankle turning inwards).

“Metatarsus adductus is not pigeon toes... and not clubbed foot...”

Metatarsus adductus is when the metatarsal bones which are the long bones in the feet turn inwards rather than straight ahead. Because baby bone is largely cartilage in the early stages it is very malleable so stretches can often resolve the problem. Unfortunately, they didn’t.

“Metatarsus adductus is when the metatarsal bones turn inwards rather than straight ahead...”

So after she had her hip splint removed and we enjoyed one week of baths and a baby photo shoot, we took her back to the paediatric physiotherapist to apply plaster of paris foot casts, that were done weekly for 4 weeks. After this she had foot splints made that she had to wear at night for the next three months. During the day I had to continue the foot stretches. She then had beautifully straight feet that would enable her to fit in to shoes more easily, have aesthetically pleasing feet and maybe make it in to a classical ballet class. 

Our daughter is now 19 months, a beautiful age. She is very active which has helped her do very well with her movement milestones. We noticed that she was quite 'pigeon- toed' (feet and legs turning inwards), so a little awkward tripping over her feet occasionally.

Children are known, as part of their development, for being intoed (pigeon toed) from around 18 months to 3 years but thought I would put the families mind at ease by visiting our well frequented paediatric physiotherapist. Unfortunately she had the trifecta on the pigeon toed stakes; her thigh bone (femur), shin bones (tibia) and feet (metatarsus adductus) were rotated inwards. The usual management is to let the leg bones de-rotate naturally over time but the feet can need a helping hand. 

“Intoed (pigeon toed)... common from around 18 months to 3 years.. can be caused by femur, tibia or metatarsal rotation...”

So we have just been through another round of serial casting, weekly casts over the shins and feet, gradually stretching out the feet. I dealt with my OCD tendencies of poorly styled oversized sandals, which were worn over the casts to allow her to walk, and we all coped really well. My husband dunked her in the bath, feet out while I washed off the daily grime but otherwise it did not affect Misaki or us at all. She now just has to wear splints at night for 3 to 6 months and hopefully that is the end of it.

Incidentally I had the same splinting done on my feet back in the late 70s when I was a baby and have perfectly straight feet. As a child I was still pigeon toed (because of inwardly rotating hips) but much less so. I was a child of the 80s where political correctness was not key, so I was chucked out of the classical ballet class because my feet turned inwards not outwards in 1st and definitely not 5th position! I am still pigeon-toed because my hips didn't completely correct so I still wouldn’t be selected for classical ballet, or jazz or contemporary for that matter but if I was coordinated or rich enough I could fit into a pair of Louboutin shoes.

Summary

Metatarsus adductus is when the metatarsal bones of the foot rotate inwards.

It can be easily fixed in an infant with stretches, casts or splinting.

If left untreated it is much harder to fix and makes it hard to fit in to shoes and affect coordination.

Melli Tilbrook is a Physiotherapist based at Adelaide Physiotherapy and Pilates Studio, Beulah Park.