UNFO

Universal Neonatal Foot Orthotics

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Metatarsus adductus report

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

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

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Metatrasus Adductus (MA), what do we know?

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

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• severe
• Not correctable past neutral
• Heel bisector at 4th toe or
beyond
• Deep medial skin crease
• moderate
• Correctable to neutral
• Heel bisector medial to 4
th
toe
• Mild or no skin crease

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• Natural History
• Most cases will resolve
spontaneously
• 11–14% persistent and require
treatment

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Treatment of Metatasus Adductus

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• Serial casting (best results up to
8-9 month old babies)
Occasionally followed by an
orthosis
• Time consuming
• messy
• Interferes with bathing & hygiene
• Slippage of the cast
• Pressure sores

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• Treatment options in unresolved
Metatarsus adductus among older children
• Ignore
• There is no functional impairment
• Surgery
• Stumbling
• Esthetics
• Footwear
• Social

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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:

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What is UNFO

[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/2″][vc_column_text]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 [/vc_column_text][/vc_column][vc_column width=”1/2″][vc_single_image image=”703″ img_size=”full”][/vc_column][/vc_row][vc_row][vc_column][vc_empty_space][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

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[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_empty_space][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Patients details

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Results
• 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

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Discussion
• About 11–14% 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

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Conclusion
• 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
orthosis
The authors declare of no conflict of interest

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