UNFO for Treatment of Metatarsus Adductus (MA)
Is casting, maltreatment or overtreatment?
4,100,767 live births are reported in 2017 in USA. 3.2 percent of them are born with MTA (wide prospective study). About 2/3 of these babies are affected in both feet with problems of various severity. Almost 132,000 babies are born, with Metatarsus Adductus every year in United States.
For about 200 years, the treatment of choice for Metatarsus Adductus, (the most common congenital foot deformity), was serial castings.
According to recent studies and publications, the benefits of physical therapy and stretching exercises have not been shown to be effective in treating MA.
Treatment with serial castings deterred therapists and patients due to the many technical difficulties, wound complications, pain and hygienic issues. As a result, in last few decades, a new, compromising concept has been introduced in most orthopaedic centres, ignoring the mild and moderate cases and treat only severe cases of MA.
Since deterioration of mild and moderate cases may happen, and treatment time is limited to 10 months of the baby’s life, many Metatarsus Adductus cases do not come to us for treatment on time and these babies are left with leg deformities for the rest of their lives.
In many cases, very expensive time is wasted on infants with MA by application of ineffective physical therapy and stretching exercises.
Early diagnosis will prevent damage to life
Since the treatment should be started in the first months of the baby’s life, and complications and dangers of serial castings may be serious, some attempts have been made in the past to sweeten the treatment by using various orthotic devices without significant success, hence the method of casting continued to be considered the ideal treatment for MA, but advised for severe cases only. This compromising attitude is the main reason for the great number of neglected MA cases referred to us for treatment – a treatment almost impossible without surgical intervention.
During the last decade, Revolutionary Universal Neonatal Foot Orthotic (UNFO) has changed the whole concept of treatment for Metatarsus Adductus.
This gentle sandal-like device has precise biomechanical properties to correct MA distortions in a very simple and effective manner, in a very short time and with only minor side effects. The device encloses the foot with only a single Velcro strap, providing dynamic 6-point correcting forces during a 3-6-week treatment, and when used later as a night brace to prevent recurrence.
Although the common opinion is that most mild and moderate cases are manageable over months or years, the lack of confidence in the prognosis, and UNFO’s innovative, simple and convenient treatment, should influence baby caregivers to recommend this safe treatment in these cases, and correct foot deformity before babies take their first steps.
Clinical studies in leading hospitals in Italy and Israel leave no doubt as regards the superiority of UNFO treatment compared to the treatment of MA by serial casting and other methods. The UNFO treatment has already become a therapeutic protocol in many medical centers around the world, and numbers are growing day by day.
There is considerable confusion at all levels of medical information dealing with the most common congenital orthopaedic problem among infants, including medical research, basic baby care screening, accurate diagnosis, follow-up and MA treatment.
This confusion is particularly evident in the widespread mistake that exists in reported MA prevalence, even in prestigious medical sites and articles, regardless of the importance of this statistical data. The historical confusion between the prevalence of Clubfoot and MA is a great absurdity that is repeatedly quoted (1-2/1000 births). It is not clear how respected authors state in articles that the incidence of Clubfoot and MA are the same.
According to reports and qualified articles, Metatarsus Adductus treatment by serial casting after the age of 10 months is not successful, unfortunately, many neglected cases start serial casting after the age of 12 months despite the high rate of recurrence.
Many questions are to be asked, and important steps taken regarding the lingering indifference and understatement that exists on the treatment of one of the most common skeletal deformity among infants:
1- Why are there no updated, qualified prospective studies on the prevalence of MA in newborns.
2- Why are there no acceptable and qualified screening of foot deformities in newborns?
3- Who is responsible for the screening failures of these affected newborns?
4- How can we prevent late diagnosis and neglected cases that have lost the opportunity for early effective treatment?
5- How can we explain casting technique after the age of 1 and even 2 years of age? Are there any clinical trials supporting serial casting after the age of 12 months?
6 -Why are there no qualified objective studies of long term MA follow- up in adults and seniors?
There appears to be no acceptable professional and conclusive protocol for the screening and treatment of the most common congenital foot deformity in newborns as there exists for Clubfoot.
It seems about time that POSNA, and other orthopaedic associations, start to enforce their authority to promote research, guidance and publication of regulations and protocol for Metatarsus Adductus treatment as the most common congenital foot deformity, for the benefit of suffering children and families. the prestige of paediatric orthopaedics.
Izak Daizade M.D Orthopaedic Surgery
UNFO Medical Center