Metatarsus Adductus · Curved-foot in infants

Metatarsus adductus — the inward-curving foot in infants and toddlers.

The forefoot curves inward relative to the heel — sometimes obvious at birth, sometimes noticed in early walking. Metatarsus adductus is the most common foot deformity in newborns, and it usually resolves on its own without any intervention. The minority that doesn’t responds well to early treatment.

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What metatarsus adductus is and how it sorts itself out.

Metatarsus adductus is a structural foot variation where the forefoot is positioned medially (inward) relative to the heel. It looks like the foot is curved — the lateral border of the foot is convex rather than straight, and the gap between the big toe and the second toe may appear wider than typical.

It’s the most common congenital foot variation, present in around one in a thousand newborns. Most cases are flexible — the foot can be passively straightened with gentle pressure — and the vast majority of these resolve on their own within the first 12 months. By 4-5 years, almost all flexible cases are indistinguishable from typical feet.

The minority of cases that benefit from intervention: rigid metatarsus adductus (the foot can’t be passively straightened), or flexible cases that aren’t resolving on the expected trajectory. These respond well to early intervention — stretching, serial casting, or occasionally bracing — particularly when started before 12 months of age.

What we assess and treat

Six aspects of metatarsus adductus assessment and care.

The right management depends on flexibility, age and trajectory. Most infants need nothing; a minority benefits significantly from early intervention.

Flexibility assessment

Can the foot be passively straightened? Flexible metatarsus adductus usually resolves; rigid metatarsus adductus warrants intervention.

Trajectory check at each visit

For flexible cases, we monitor whether the foot is straightening on the expected timeline. Most do; the few that don’t become candidates for active treatment.

Stretching exercises for parents

Simple gentle stretching exercises taught to parents at home. For flexible cases, this is often all that’s needed.

Serial casting for resistant cases

For rigid cases or flexible cases not resolving, a series of plaster casts (changed every 1-2 weeks) gently corrects the foot position. Best results when started before 12 months.

Footwear advice once walking

Once a child is walking, supportive footwear that doesn’t worsen the curve. Old advice about reverse-last shoes is no longer routinely recommended.

Reassurance for the family

For most infants, the most useful thing we provide is understanding the natural history. Parents worry about how the foot looks; the foot will look normal in a few years.

How we approach it

Three steps from first visit to outcome.

Assessment.

A 30-45 minute paediatric podiatry assessment. Visual and palpation assessment of the foot, flexibility testing, and a discussion of what to expect over the next 6-12 months.

Treatment plan.

For most flexible cases: stretching exercises and monitoring. For rigid or persistent cases: serial casting or referral to an orthopaedic surgeon where appropriate. Treatment is age-sensitive — younger is better.

Review and progression.

Reviewed at 3-6 month intervals. Most cases discharged within 12-18 months as the foot resolves. Rigid cases followed longer through the casting phase and beyond.

HICAPS on the spot with every major fund · Medicare GPCCMP, DVA, NDIS & WorkCover accepted where applicable.