Treating Forefoot Adduction in Children

There are many different terms that describe various specific misalignments in a child’s feet, such as clubfoot and skewfoot. Forefoot adduction tends to be a bit simpler and more general of a term, and is among the most common symptoms that can be noted at birth. This does not mean that it is any less worthy of careful monitoring, of course!

The good news is that most cases of forefoot adduction do not require treatment and will go away on their own as your child develops. But paying proper attention to the condition and assuring intervention happens as soon as possible if needed can help avoid complications in the future.

What is Forefoot Adduction?

An “adducted” forefoot is simply one in which the front part of the foot is turned inward.

You might also hear this condition referred to as metatarsus adductus when it is isolated, but it can also be part of other conditions.

Forefoot adduction occurs in about 1 in 1,000 births. It can be present in one or both feet, with about an even chance for each instance. The condition might remain present as a child walks, leading to in-toeing. Many parents might notice symptoms within the first year of their child’s life.

The precise cause of an adducted forefoot is yet to be confirmed, but the position of the child within the womb and the forces upon him or her may be contributing factors. Chances of adduction tend to be higher in first-time pregnancies, twin pregnancies, and overdue pregnancies. There is no clear action at this time parents can take to prevent this condition, and they are not at fault in any way.

How is Forefoot Adduction Diagnosed?

We can easily diagnose forefoot adduction with a physical exam. We will also take the time to discuss the history of your child’s birth and other factors surrounding your case, such as whether others in your family have experienced similar conditions.

Part of the examination will involve placing gentle pressure on your child’s forefoot to test its flexibility. The majority of cases are flexible, meaning the foot can be easily held to a properly aligned position with little pressure. 

There may be some cases, however, where an adducted forefoot may be more resistant to manipulation or largely nonflexible (unable to be placed within proper alignment). These are situations that will most likely require greater attention.

How is Forefoot Adduction Treated?

As we noted earlier, the vast majority of forefoot adduction cases – around 90%, according to some sources – will resolve on their own by the time a child turns 4 years old. As a child grows and their musculoskeletal system develops, the feet will naturally “fall in line.”

But it still remains important to follow along with a child’s development and ensure that their feet are gradually correcting themselves. Our concern lies with the approximately 10% of cases that are either nonflexible or don’t resolve on their own. Additionally, cases in children who aged 5 years or older will typically fall into this category automatically, as the time for self-correction through growth has usually passed.

By keeping a child under periodic observation, we can start taking steps to address and treat forefoot adduction if it looks like the matter will not improve on its own.

Treatment will largely depend on the severity of the condition and its relative flexibility. That will often dictate what we may need to do to straighten the forefoot and restore proper alignment.

A treatment plan for a curved forefoot may include:

• A regimen of stretching and manipulation exercises to help condition and strengthen the structure of the feet. Some of these might be performed at our office, while others can be performed at home. A parent’s participation will likely be required, and we will gladly train you on how to best work with your child.
• The use of special shoes, braces, or other equipment to help hold the forefoot in place.
• The use of casting to gently stretch the tissues of the forefoot and guide the foot into its proper position. Casts may extend up the full length of the leg and will need to be changed every 1-2 weeks to keep up with the gradual shifting of the forefoot.

In rare cases, if the adduction is severe, nonflexible, or has some other form of major complication, surgery may be considered to release the joints of the forefoot and allow relief. Casting is often needed following surgery to hold the forefoot in place as it heals.

The Treatment Families Need – When They Need It

While there is often little to worry about when forefoot adduction is identified in a young child, the best peace of mind comes from knowing that treatment can begin as soon as possible should it become a problem. Our mission is to always provide sound guidance for families, no matter the circumstances.

Schedule an appointment at our Ladera Ranch office by calling (949) 364-9255 (WALK) or by filling out our online contact form. We’ll be happy to hear from you.