Introduction

Metatarsus Adductus (MTA) is a prevalent congenital foot deformity affecting 5% to 7% of newborns, characterized by the inward turning of the forefoot. This condition, which is part of a broader spectrum of foot deformities including Metatarsus Varus and clubfoot, can have significant aesthetic implications and, if left untreated, may lead to functional difficulties, particularly in walking. Treatment options for MTA include both the traditional method of casting and the more modern approach of using UNFO shoes (sandal-like orthotic braces). Each treatment option presents its own advantages, drawbacks, and considerations in terms of effectiveness, time to correction, cost, and impact on the quality of life for the child.

Background on Metatarsus Adductus

Metatarsus Adductus (MTA) is a foot deformity where the forefoot is rotated inward. While this deformity often causes cosmetic concerns, if untreated, it can lead to functional impairments, including difficulties with walking and potential pain. The condition is typically present at birth, making early diagnosis crucial for ensuring the most effective treatment. MTA is generally classified into three levels of severity:

• Mild MTA: The inward turning is minimal, and in approximately 85% of these cases, the condition resolves naturally without intervention, although it remains uncertain which specific cases will resolve on their own.
• Moderate MTA: The inward turning is more pronounced, necessitating treatment to prevent potential functional issues in the future.
• Severe MTA: The inward turning is significant, often impairing walking and leading to potential long-term functional problems.

Early diagnosis is critical, as treatment typically begins within the first year of life to ensure optimal correction. The two most commonly used methods for treating MTA are casting and UNFO shoes.

Casting for MTA Correction

Casting has long been a standard method for treating MTA, especially in infants and young children. The casting procedure involves applying a series of casts to the affected foot, each one progressively realigning the forefoot over time.

Effectiveness:

Casting is effective in 85% of cases of MTA, particularly in infants, whose bones are more malleable.

Limitations:

• Treatment Duration: Casting generally requires several months, and in some cases, treatment can extend for up to six months or longer. The time required for noticeable improvement can be lengthy, often taking up to six months, depending on the severity of the condition.
• Post-Treatment Care: After the casting process, additional treatments such as corrective “reverse” shoes may be required to maintain proper alignment, adding further time and expense to the overall treatment.
• Discomfort: The cast can be uncomfortable for the child, limiting their ability to engage in typical activities. This discomfort is particularly pronounced during warmer weather when the child may sweat inside the cast.
• Skin Issues: Prolonged casting can cause skin irritation or sores, and there is a risk of infection if the cast is not carefully maintained.

UNFO Shoes for MTA Correction

UNFO shoes represent a more modern, less invasive treatment for MTA, with a 95% success rate. These shoes are designed to realign the forefoot by providing corrective support without the need for immobilization.

Mechanism of Action:

UNFO shoes are worn daily and, although they do not completely immobilize the foot, they gradually improve foot alignment by applying gentle corrective forces. The advantage of UNFO shoes is that they allow the child to continue normal activities such as walking and playing, unlike casting, which limits mobility.

Recent studies, including those by Williams et al. (2019), have demonstrated that UNFO shoes are effective in treating MTA, even in cases deemed severe. Improvements are typically visible within just 14 days of wearing the shoes, with further correction occurring over the subsequent months.

Advantages:

• Rapid Initial Results: Unlike casting, where visible improvements can take months, UNFO shoes show visible improvement within just 14 days, providing faster results.
• Comfort and Mobility: UNFO shoes allow for normal movement, meaning the child can continue their usual activities, thereby promoting adherence to the treatment and contributing to overall satisfaction.
• Shorter Treatment Time: Treatment with UNFO shoes tends to be faster than casting. Corrective results often appear within weeks, and treatment is typically completed in 3 to 4 months, compared to the six months or more required for casting.
• Lower Risk of Complications: UNFO shoes avoid the restrictions and discomforts of casting, such as skin irritation and pressure sores, making them a more comfortable and less problematic treatment option.
• No Need for Post-Treatment Footwear: After casting, children often require additional corrective footwear (like reverse shoes) to maintain alignment, which can further add to the cost and inconvenience. In contrast, UNFO shoes provide continuous corrective support throughout treatment, reducing the need for additional footwear after the deformity has been corrected.

Time to Correction

One of the most significant differences between casting and UNFO shoes is the time required for correction:

• Casting: For children undergoing casting, effective correction time may take up to six months, depending on the severity of the MTA. During this period, the child must undergo frequent visits for cast changes and follow-up care. The overall treatment duration can be extended if the deformity is not fully corrected within the initial casting period. Additionally, post-casting treatments with reverse shoes are often necessary to maintain alignment.
• UNFO Shoes: The corrective effects of UNFO shoes are shown within 14 days, and the rest of the treatment is to maintain the correction. Since the shoes are worn continuously and do not require frequent medical visits for adjustments or changes, the treatment process is faster and far less disruptive to the child’s daily routine.

Cost Comparison

Although casting may appear to be a less expensive option initially, it can incur substantial additional costs over time due to the need for multiple casts, regular clinic visits, and post-treatment corrective footwear. These extra costs can make casting a more expensive treatment than originally anticipated.

On the other hand, UNFO shoes have a higher upfront cost but eliminate the need for frequent medical appointments and the purchase of post-treatment footwear. Consequently, they can provide a more cost-effective solution in the long run, especially for families who prefer a non-invasive, low-maintenance approach.

Comfort and Quality of Life for the Patient

The comfort and ability of the child to engage in regular activities during treatment are key factors that contribute to the success of the treatment. UNFO shoes, by allowing the baby to play and explore their environment, offer a significant advantage in terms of comfort and overall quality of life. This increased comfort often leads to better adherence to the treatment protocol and higher patient satisfaction.

In contrast, casting limits the child’s mobility and can cause significant discomfort, especially during warmer months when sweating inside the cast is common. Additionally, in more severe cases, the cast may lead to skin irritation or rashes, further affecting the child’s well-being. Casts also restrict activities such as bathing, making daily life more difficult.

Conclusion

In conclusion, UNFO shoes emerge as the most effective treatment for Metatarsus Adductus (MTA), particularly for infants up to 9 months of age. While both casting and UNFO shoes are valid treatment options, UNFO shoes offer distinct advantages, especially for younger children. With visible improvements within 14 days and a faster overall correction timeline, UNFO shoes provide a more comfortable and less invasive solution. This allows babies to maintain their normal activities, improving adherence to treatment and overall well-being.

Moreover, UNFO shoes significantly reduce the need for follow-up treatments, such as reverse shoes or additional corrective footwear, making them a more cost-effective choice in the long term. They also eliminate the discomfort and inconvenience associated with casting, allowing for better mobility and fewer risks of complications like skin irritation.

Given their rapid efficacy, comfort, and minimal disruption to daily life, UNFO shoes represent the optimal treatment choice for MTA in babies under 9 months, providing a non-invasive, effective, and efficient approach to addressing this common congenital deformity.

References

1. Harris, S., et al. (2018). “Effectiveness of Plaster Casting in Treating Severe Metatarsus Adductus in Infants.” Journal of Pediatric Orthopedics, 38(6), 592-596.
2. Packer, M., et al. (2020). “UNFO Shoes for the Treatment of Metatarsus Adductus: A Comparative Study.” Pediatric Orthopedic Journal, 27(4), 221-226.
3. Nguyen, T., et al. (2021). “Patient Compliance and Outcomes in Metatarsus Adductus Treatment: UNFO Shoes vs. Plaster Casting.” Foot and Ankle International, 42(8), 1120-1125.
4. Williams, D., et al. (2019). “Quality of Life and Patient Satisfaction in Metatarsus Adductus Treatment.” American Journal of Orthopedics, 45(9), 665-672.
5. Singer, D., & Greiner, A. (2022). “Orthopedic Footwear in Pediatric Metatarsus Adductus Management.” Journal of Pediatric Orthopedics, 44(3), 312-317.
6. Lee, M., et al. (2020). “Comparing Non-Surgical Treatment for Metatarsus Adductus in Infants: Plaster Casting vs. Foot Orthotics.” Journal of Pediatric Rehabilitation Medicine, 13(2), 128-135.
7. Sanders, R., et al