Critical points in treatment of MTA & Clubfoot

Current Problems in the Treatment of Metatarsus Adductus

The appropriate treatment for metatarsus adductus is based on the severity of the condition, and recommended options may include observation, stretching, strapping, casting, and/or surgery.  Mild and moderate forms (which comprise around 85 percent of patients) are typically treated initially with stretching exercises administered by the child’s parents.

Despite its common practice, the effectiveness of stretching is highly questionable, and many parents are unable to effective partake in stretching treatments with their child.  If the deformity is not resolved within 2 to 4 months, active medical intervention (like serial casting  or bracing) is recommended.  Leg casts may be applied every two weeks for a period of 6 to 12 weeks.

However, the physician must take into consideration that casting and bracing is most effective prior to 6 months of age and ineffective after the age of 12 months.  Severe and rigid MTA patients (which comprise around 15 percent of cases) may be prescribed a serial casting or bracing program in the first weeks of life.  Severe cases may require night splinting to maintain correction after the removing the serial casting, with some physicians advocating splinting as a monotherapy. Failure of conservative treatment in children older than 2 years of age may require surgery.

Problems with Serial Casting

Currently, serial casting is considered to be the most effective treatment of MTA.  However, the treatment has a number of distinct complications and disadvantages – including:

  1. Defective Casting.  An improper casting technique can lead to crowded toes, pressure sores, dangerous circulation problems, and other foot deformities.
  2. Hygiene Problems.  As the cast must be kept dry, hygiene can become difficult.  Urine and other foreign debris can enter the cast and cause skin irritation.
  3. Infant Stress.  A cast is uncomfortable and stressful for a child, and patients often cry and scream during the casting and its removal.  Heightened stress of this type during infancy can cause psychological problems.
  4. Parental Stress.  Parents experience anxiety and stress, because of the unfamiliar and uncomfortable treatment administered to their precious child and the uncertainty of treatment outcome and complications. Parents may also encounter social problems exposing their treated baby to family, friends and community.
  5. Under-treatment.  Many physicians believe that serial casting (which was originally developed for clubfoot) is too harsh of a treatment for MTA.  Practitioners often recommend minimal or no treatment for metatarsus adductus, hoping nature and time will correct the deformity.
  6. Time-consuming.  Casting is an extremely long and time-consuming process, causing unnecessary stress for both the infant and his or her family.

The UNFO brace is an easy, sensible, and stress-free option for the treatment of foot deformities like metatarsus adductus and club foot.  The specially-designed orthotic shoes can be applied at home by the child’s parents and removed for bathing or other activities.  The shoes are not uncomfortable and do not cause the child any pain.