A reappraisal of metatarsus adductus and skewfoot.

The hypothesis that the treatment of adduction of the fore part of the foot in the child is altered by an associated deformity of the middle or the hind part, or both, was tested in a prospective study of eighty-four patients (124 feet). Radiographic classification delineated four configurations of adduction of the foot, based on varying relationships of the fore, middle, and hind parts of the foot. Twenty-two (43 per cent) of the feet with adduction of the fore part alone (simple metatarsus adductus) required no treatment, as compared with eighteen feet (24 per cent) with the other types of adduction (p less than 0.03). The patients with a complex skew-foot deformity required twice as long a period of cast treatment as those with simple metatarsus adductus (p = 0.0001). On evaluation at a minimum follow-up of two years, only one of the 124 feet had residual adduction of the fore part of the foot, as determined radiographically. It was also found that the use of the Denis-Browne bar was accompanied by an increased incidence of flat-foot deformity at follow-up.