• Papadopoulou AE

• Affiliation / Private Practice
• Affiliation(G) / Cyprus / Nicosia
• Foot Joints
• Infant
• Infant Care
• Metatarsus Varus
• Open Access Document
• Pediatric Chiropractic
• Physical Examination
• Review Literature as Topic
• Toes / abnormalities

Background: Metatarsus adductus (MA) is a common lower limb torsional abnormality that affects 1/1000 births and is one of the reasons for in-toeing in children. This condition has a good prognosis as it commonly spontaneously recovers around the school-age years, with 10-15% of cases persisting. At present there is a lack of agreement in terms of definition, standard approach of measurement and documentation criteria and robust evidence for the validity of intra- or inter-examiner reliability. This creates a barrier in monitoring and referring cases appropriately between clinicians as well as providing prognosis and reassuring parents. The aim of this study was to align the clinical needs of documentation and observation in these common clinical cases.

Method: Literature search of the Cochrane library, Pubmed and ScienceDirect was undertaken.

Keywords used: ‘MA’, ‘Intoeing’, ‘measurements/classification’, in English language, 1-3 years, excluding congenital abnormalities and neurological causes. Articles identified were screened for relevance and references were further assessed.

Results: 173 articles were identified of which 18 fulfilled the requirements. Out of the 8 relevant articles, only 3 were fully compatible with the age in question. Techniques to measure metatarsus adductus included the heel bisector method, photocopies, ultrasound, footprints, dynamic foot pressure and radiographs. Radiographs are considered inappropriate for the toddler age group. Lack of robust evidence was an issue with identifying inter- and intra-rater reliability with both radiographic and non-radiographic findings, especially in relation to the pediatric population.

Conclusion: Clinicians can use history and physical examination to rule out ‘red flag’ findings and other pathologies and monitor the progress using non radiographic methods. Given the lack of skeletal maturity, as well as the radiosensitivity in the toddler age group, x-rays should be avoided unless indicated for intervention.

Author keywords: Pediatrics, metatarsus adductus, intoeing, toddlers/infants, classification, measuring tools, inter/intra reliability

Author affiliation: Private Practice, Agioi Omologites, Nicosia, Cyprus
Corresponding author: Anna Papadopoulou—anna.chiropractic@gmail.com

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