Metatarsus adductus report

Universal Neonatal Foot Orthotics (UNFO): A Novel Method to correct forefoot adduction, Preliminary report

Avi Panski, Naum Simanovski, Vladimir Goldman, Ron Lamdan Pediatric Orthopedics Unit,
Hadassah medical center, Jerusalem

Metatrasus Adductus (MA), what do we know?

The most common foot deformity in newborns: 1-2/1000 births

Not correctable past neutral
Heel bisector at 4th toe or
Deep medial skin crease
Correctable to neutral
Heel bisector medial to 4
Mild or no skin crease
Natural History
Most cases will resolve
1114% persistent and require

Treatment of Metatasus Adductus

Serial casting (best results up to
8-9 month old babies)
Occasionally followed by an
Time consuming
Interferes with bathing & hygiene
Slippage of the cast
Pressure sores
Treatment options in unresolved
Metatarsus adductus among older children
There is no functional impairment

Materials and methods

• Retrospective study of our first 15 consecutive patients treated with UNFO (June 2014 – November 2015)
• Follow up of 2 months minimum after cessation of treatment
• Treatment protocol:

What is UNFO

Universal Foot Orthotics
2 sizes

3 point pressure
Heel held firmly
Point of pressure against the 1st metatarsal head
Strap for increasing pressure gradually over base of 5th metatarsus

metatarsus adductus shoes
UNFO treatment protocol

• UNFO was first applied for 23 hours a day
•Weaning gradually when full correction was achieved
•3-4 weeks 18 hours
• 3-4 weeks 12 hours night time
• Stop UNFO
• (if the parents wish, continue night time bracing as long as it fits)
• Follow-up 3 week
• Follow-up when walking
• Follow-up at the age of 1.5 and 2 years

Patients details

15 patients, 22 feet (5 Lt 3 Rt 7 bilateral) followed until
end of treatment
7 Patients severe Metatarsus adductus (11 feet)
8 Patients moderate Metatarsus adductus (11 feet)
Age at beginning of treatment 3.1-7.2 months (average 5
months +2 weeks)
Time to full correction: following visit (4 days-3 weeks)
Final outcome – resolution of Metatarsus adductus in all cases
Side effects minor
Superficial wounds 1
Redness of the skin 4
Slippage of UNFO 2
Device wear 1
Excessive sweating 1
About 1114% of Metatarsus adductus do not resolve spontaneously
The optimal age for treatment of Metatarsus adductus is up to the age of 9 months
Treatment options include serial casting or usage of adjustable orthosis
We present our experience with treatment of Metatarsus adductus among young babies using a
new orthosis – UNFO – which fits tightly to the babies foot and by the three-point
fixation principle corrects the deformity
The amount of pressure over the apex of the deformity is controlled by an
adjustable velccro strap easy to apply and manipulate by the baby’s caregivers
This method is better tolerated by the infant and caregivers and is less time and
effort consuming then serial casting
In comparison to the Bebax orthosis UNFO is easily applied and manipulated by
one caregiver
In comparison to the Wheaton brace the advantage of UNFO is leaving the ankle
joint and leg out of the brace
Treatment was begun as soon as the baby was diagnosed as having severe Metatarsus adductus or
only if spontaneous resolution has not occurred up to the age of 6 months
Correction was achieved within 3 weeks with only few minor side effects
Metatarsus adductus in infants should not be ignored
Severe deformities or deformities which have not improved
spontaneously up to the age of 6 months should be treated
Treatment with UNFO is a safe and effective method to correct
metatarsus adductus deformity in infants up to the age of 9 months
There were only minor side effects as redness of the skin or
superficial wounds which healed after a day or two without the
The authors declare of no conflict of interest