# Metatarsus adductus

> Metatarsus adductus is a common baby foot shape where the front half of the foot turns inward, giving a C or bean shape, while the heel is normal. Most feet are flexible and correct on their own over the first few years. Stiff or severe feet are usually treated with casting.

Guide in [Foot shape and posture](https://footanklelowerlimb.com.au/learn/topics/foot-shape-and-posture), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/metatarsus-adductus
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 11 November 2026.
Next review by 11 November 2027.

- **The front of the foot turns inward,** giving a C or bean shape, while the heel and ankle are normal.
- **It's usually noticed at birth** and is linked to the baby's position in the womb.
- **Most feet are flexible,** and flexible feet usually correct on their own over the first few years.
- **Stiff or severe feet are treated differently,** most often with a series of casts.
- **The hips are checked** because hip dysplasia can occur alongside it.

## What is metatarsus adductus, and how common is it?

Metatarsus adductus (also called metatarsus varus or forefoot adductus) is a foot shape in which the front half of the foot turns inward at the tarsometatarsal joint (a joint in the middle of the foot), while the heel and ankle sit normally [1]. Seen from above or from the sole, the foot looks C-shaped or bean-shaped [2]. It can affect one foot or both [3].

It is the most common foot deformity present at birth [4]. How often it occurs depends on the estimate: about 1 to 2 in every 1000 births [4], or 0.1% to 1% of births [2]. In the past it was reported more often in girls [2].

Most cases are flexible, which means the foot can be gently guided back toward a normal position [5].

## What causes it, and who gets it?

It's thought to be related to the position the baby lay in during pregnancy [3]. Often it results from cramped space in the womb, and the shape is evident from birth [6]. It can be positional (flexible) or structural (fixed) [7]. Beyond womb position and the past tendency in girls, it isn't clear yet who is more likely to have it.

## How is it noticed and diagnosed, and what can make it serious?

It's usually noticed by a parent or midwife soon after birth, or when the feet are checked at the newborn examination [8]. The front of the foot turns in, the heel looks normal, and there may be a gap between the big toe and the second toe [9]. A very mild case may not be noticed until a child starts walking and toes in [10].

Diagnosis is made by looking at and moving the foot. The key step is judging how flexible the forefoot is. It's flexible if it can be moved past straight, semiflexible if it can only be brought to straight, and rigid if it can't reach straight [2]. The whole leg (hip, knee and foot) and the way a child walks are also checked [2].

Some features make it more significant:

- **A rigid foot** that can't be brought to the middle suggests a fixed (structural) deformity rather than a positional one [7][5]. It may call for orthopaedic (bone and joint) care, which in selected cases includes casts or a surgical opinion [5].
- **A stiff foot** that isn't fully correctable, is painful, or isn't improving within a few months can also mean a fixed deformity [3]. Pain, or a foot that isn't working normally, also makes it more significant [2].
- **The hips.** Hip dysplasia (a hip joint that hasn't formed properly) can occur alongside metatarsus adductus or on its own [2], so a careful hip examination is advised for a baby with it [11]. A hip ultrasound scan at around six weeks is sometimes arranged [3].
- **Skewfoot.** Long-standing untreated or undertreated adductus can worsen into skewfoot, with more marked symptoms and deformity [12]. In rare uncorrected cases the foot can become Z-shaped [13].

A few other problems can look similar or occur with it:

- **Clubfoot** also involves the ankle pointing down (equinus). Metatarsus adductus doesn't [2].
- **Internal tibial torsion** is a twisted shin bone that turns the foot in while the kneecaps point forwards [6].
- **Residual clubfoot** can come back, usually in children over three, looking like metatarsus adductus [13].

## What helps first?

For flexible feet, watching is the usual first step. Treating flexible metatarsus adductus isn't needed, and the evidence for treating semi-rigid feet is limited [4]. Most cases are managed by watching the foot and reassuring the family [2]. Flexible feet begin to correct within the first 3 months [2].

Milder cases are managed with follow-up or stretching of the foot [14]. Special shoes, orthotics (shoe inserts), braces and physiotherapy are kept for feet that aren't improving [2], and there's little to show that orthotics or braces help [15].

Sleeping on the tummy and W-sitting (sitting with the knees bent and feet out beside the hips) don't make it worse. That idea is a myth [2].

> [!tip] Try this
> Every month or so, take a photo of your baby's foot from above, with the foot relaxed and in the same position each time. It makes it easier to see whether the curve is easing.

## What helps if that isn't enough?

Serial casting is the usual next step for a rigid or severe foot, or one that isn't starting to correct on its own [2][14]. The casts help move the foot into position, and they're usually changed weekly, guided by a physiotherapist [16]. For a moderate or severe stiff foot in a baby, treatment with a below-knee plaster cast can take around 6–8 weeks [17]. Skewfoot needs about twice as long in casts as simple metatarsus adductus [18].

The evidence for casting is limited, and it isn't clear yet exactly when to move from stretching to casting.

## What is the outlook, and can it come back?

The outlook is generally good, because most flexible feet correct without treatment. About 90% of cases have corrected by 1 year of age [2]. Most babies' feet settle over the first two to three years without treatment [11], fully by around age three [10], and by age four in 95% of cases [3]. A flexible foot is expected to have settled by age 2, and if it lingers it typically causes no symptoms [2].

Flexibility is the main thing that shapes the outlook. If a severe deformity doesn't go away, it can lead to foot problems such as bunions or hammertoes later in life [16].

It isn't clear yet whether any footwear, positioning or stretching programme stops it coming back.

## Common questions

### Is metatarsus adductus the same as in-toeing?

Not exactly. In-toeing describes how a child walks, with the toes pointing inward. Metatarsus adductus is one cause, where the front of the foot itself turns in. A twisted shin bone (tibial torsion) is another cause, and it can look similar from the outside.

### Can I stretch my baby's foot at home?

Stretching of the foot is one of the options used for milder cases. It isn't clear yet how well parent-led stretching works or how much is best. Many flexible feet correct on their own with watching alone, so stretching isn't always needed.

### Does metatarsus adductus cause pain or stop a child walking?

A flexible foot that lasts longer than expected typically causes no symptoms. Very mild cases may only be noticed once a child starts walking and toes in. Pain, or a foot that isn't working normally, makes the picture more significant.

## Further reading

- [Metatarsus adductus on Clindice](https://clindice.com/metatarsus-adductus)
- [Metatarsus Adductus: Signs, Symptoms, Causes & Treatment](https://my.clevelandclinic.org/health/diseases/22911-metatarsus-adductus), Cleveland Clinic
- [Metatarsus adductus: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001601.htm), MedlinePlus
- [Intoeing | NUH](https://www.nuh.nhs.uk/intoeing/), NHS
- [Intoeing in Children](https://www.ulh.nhs.uk/wp-content/uploads/2026/07/Intoeing-in-Children.pdf), NHS
- [Paediatric Orthopaedic Problems Age 0 – ≤15 years – GP Gateway](https://www.coventryrugbygpgateway.nhs.uk/pages/paediatric-orthopaedics/), NHS

## Sources

1. Review of current concepts in metatarsus adductus · Freedman JD, Eidelman M, Apt E et al. · Pediatric Annals · 2024. https://doi.org/10.3928/19382359-20240206-02
2. Intoeing · Gonzales AS, Ampat G, Dixon M · NCBI Bookshelf · 2023. https://www.ncbi.nlm.nih.gov/sites/books/NBK499993/
3. Metatarsus adductus · University Hospitals Dorset NHS Foundation Trust. https://www.uhd.nhs.uk/uploads/about/docs/our_publications/patient_information_leaflets/Childrens_therapy/Childrens_physiotherapy/Metatarsus-adductus.pdf
4. Metatarsus adductus: development of a non-surgical treatment pathway · Williams CM, James AM, Tran T · Journal of Paediatrics and Child Health · 2013. https://doi.org/10.1111/jpc.12219
5. Angular and Rotational Lower Limb Alignment Variations in Children: Practical Guidance for Paediatricians · Vlaic J, Kruk A, Wasko MK · Medicina (Kaunas, Lithuania) · 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC13515473/
6. In-toeing · York and Scarborough Teaching Hospitals NHS Foundation Trust. https://www.yorkhospitals.nhs.uk/childrens-centre/your-childs-hospital-journey/therapy-services/physiotherapy/in-toeing/
7. Limb problems in neonates · Safer Care Victoria. https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/limb-problems-in-neonates
8. Metatarsus Adductus · Hull University Teaching Hospitals NHS Trust · 2025. https://www.hey.nhs.uk/patient-leaflet/metatarsus-adductus/
9. The Royal Hospital for Children and Young People · NHS Lothian. https://www.rightdecisions.scot.nhs.uk/media/aplhzvnu/nhs-lothian-foot-deformities-guideline-10-10-24.pdf
10. Metatarsus Adductus Fact Sheet · St George's University Hospitals NHS Foundation Trust. https://www.stgeorges.nhs.uk/wp-content/uploads/2023/09/Metatarsus-Adductus.pdf
11. Metatarsus adductus · West Suffolk NHS Foundation Trust. https://www.wsh.nhs.uk/CMS-Documents/Patient-leaflets/TraumaandOrthopaedics/6084-1-Metatarsus-adductus.pdf
12. Metatarsus adductus and skewfoot deformity · Wan SC · Clinics in Podiatric Medicine and Surgery · 2006. https://doi.org/10.1016/j.cpm.2005.10.008
13. Forefoot adduction in children. Management and treatment. · Najdi H, Mouarbes D, Makhour F et al. · Le Journal Medical Libanais · 2016. https://doi.org/10.12816/0031521
14. Metatarsus adductus - a common deformity - what to do and when? · Apt E, Freedman JD, Eidelman M et al. · Harefuah · 2024. https://pubmed.ncbi.nlm.nih.gov/38616633/
15. Lower Extremity Abnormalities in Children · Baird DC, Dickison CG, Spires HI · American Family Physician · 2025. https://pubmed.ncbi.nlm.nih.gov/39964924/
16. Metatarsus adductus (inward turning foot) · Royal Berkshire NHS Foundation Trust. https://www.royalberkshire.nhs.uk/media/un5bodcs/metatarsus-adductus_apr25.pdf
17. Below-Knee Plaster Cast for the Treatment of Metatarsus Adductus · Katz K, David R, Soudry M · Journal of Pediatric Orthopaedics · 1999. https://doi.org/10.1097/01241398-199901000-00011
18. A reappraisal of metatarsus adductus and skewfoot · Berg EF · Journal of Pediatric Orthopaedics · 1987. https://doi.org/10.1097/01241398-198703000-00043

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