Module 45, General Orthopaedist Level

A 2 year old boy was seen for evaluation of intoeing. He had been previously diagnosed with bilateral metatarsus adductus at another institution. His prior treatment consisted of serial casting for eight weeks which began shortly after birth, this was followed by corrective shoes until 12 months of age. His parents felt that the metatarsus adductus had improved since birth, however they still had concerns over the residual deformity. They denied that their child had any functional problems. There was a positive maternal family history of "intoeing" which was treated with a Dennis Browne bar and corrective shoes. Examination revealed a well-appearing child. He had bilateral mild internal tibial torsion, however the major component of his intoeing appeared to be secondary to bilateral metatarsus adductus deformities which were supple and flexible and they were both able to be corrected to neutral position.

Question 45A

Now at age two, this child should have a course of cast treatment for 12 weeks.

Question 45B

This suggests that the casting was not effective and surgical correction should be considered.

Question 45C

X-rays should be obtained to rule out a more severe foot deformity.

Question 45D

This may be the presentation of a serpentine foot deformity and therefore needs more aggressive treatment than isolated metatarsus adductus.

Question 45E

The definitive test for separating a severe metatarsus adductus from a mild skew foot is with AP x-rays of the foot and measuring the talar-first metatarsal angle.