SLR - April 2023 - Brady Webb, DPM
Title: Universal neonatal foot orthotics—a novel treatment of infantile metatarsus adductusReference: Panski A, Goldman V, Simanovsky N, Lamdan M, Lamdan R. Universal neonatal foot orthotics-a novel treatment of infantile metatarsus adductus. Eur J Pediatr. 2021 Sep;180(9):2943-2949. doi: 10.1007/s00431-021-04048-5. Epub 2021 Apr 9. PMID: 33835248.
Level of Evidence: Level III
Scientific Literature Review
Reviewed By: Brady Webb, DPM
Residency Program: Rochester General Hospital, Rochester, NY
Podiatric Relevance: Metatarsus adductus is a common deformity encountered in children and adults. Metatarsus adductus causes patients to have increased peak plantar pressures on the lateral side of the foot. If untreated in childhood it can lead to biomechanical abnormalities that contribute to the development of hallux valgus, non-traumatic osteoarthritis, Jones fractures, generalized lateral column pain, ankle instability and peroneal tendon pathologies. The goal of this study was to evaluate the effectiveness of Universal Neonatal Foot Orthosis for the treatment of pediatric metatarsus adductus.
Methods: Patients with moderate to severe metatarsus adductus were treated with the use of Universal Neonatal Foot Orthosis (UNFO). In the cases of rigid deformity UNFO treatment was started from the first appointment. In patients with a flexible deformity that didn’t see spontaneous improvement of deformity treatment were started on treatment after the age of five months. Once correction of deformity was appreciated, the patient would be weaned off the orthotics. Additional follow up was performed until the patient was of walking age. Evaluation of correction of the deformity was assessed with utilization of the heel bisector line (HBL). The deformity was measured before, during and after completion of treatment.
Results: 71 patients (114 feet) participated in the study. 102 feet were diagnosed with a severe deformity with a heel bisector line at or lateral to the fourth toe. 12 were diagnosed with a moderate deformity with a heel bisector line between the third and fourth toes. At the end of follow up, 56 patients (98 feet) had significant improvement of deformity when follow up was completed. In 11 children (11 feet) no change was found when follow up was completed. Three children (3 feet) were found to have worse deformity when follow up was completed. Finally, one child (2 feet) that discontinued treatment after six weeks had a worse deformity in one foot and no change in the other. Only minor side effects of skin redness and superficial bruising were observed in 11 patients. All of these side effects eventually resolved.
Conclusions: Treatment of metatarsus adductus deformity is effective with use of UNFO for patients with severe deformity younger than ten months. The treatment’s effectiveness compares with serial casting and other bracing techniques with little to no adverse effects. This study was limited by the lack of a control untreated group which the authors cited ethical concerns of non-treatment for patients with moderate to severe deformities. Future studies could potentially involve the use of a cast or bracing control group to better compare outcomes of treatments.