Metatarsus varus

Metatarsus varus (pes adductus, metatarsus adductus) is a non-positional foot defect. Congenitally varus metatarsals can be of three types:

Metatarsus varus congenitus
This is a medial subluxation in the tarsometatarsal joints (Lisfranc joint).
 * Clinical picture
 * all metatarsals in adduction (forefoot curled inward) and inversion
 * heel in neutral position / slight valgus
 * child walks with toes inward, medial edge of foot concave, outer edge convex
 * Therapy
 * requires intensive treatment
 * always conservative at first: start with exercise (pressure on medial surface to align foot to correct position), a series of corrective plaster bandages over the knee, modeled so that corrective pressure is directed over metatarsals laterally (duration of individual fixations 1-2 weeks, 6-8 weeks overall, rarely longer)
 * if the deformity persists: around the age of 2 years operations on soft tissues (tendons and joint capsules), from the age of 3 years osteotomy over the metatarsal bases followed by transfixation with Kirschner wires and plaster fixation for 6 weeks (however, it is better to wait until the child is 5-6 years old, when there is no longer a risk of injury to the growth splays)

Sickle foot

 * synonyms: dog serpens, skewfoot, zig-zag fuss
 * rare defect
 * Clinical picture
 * metatarsal varicosity, heel valgus
 * talocrural joint in anteroposterior projection on rtg spherical
 * toe retracted into adduction most, forefoot creates a bayonet-like deformity (pes serpens)
 * Therapy
 * treatment is initiated conservatively (RHB and cast fixation)
 * if unsuccessful, operate (capsulotomy, tendon intersection of m. abductor hallucis, osteotomy of the calcaneus)

Residual deformity

 * after treatment PEC
 * cases where adduction of the forefoot persists

Related articles

 * Congenital defects of the limbs
 * Arthrogryposis multiplex congenita
 * Non-union of leg defects
 * Positional foot defects
 * Pes equinovarus congenitus