Much confusion surrounds the incidence and management of deformities of the forefoot because 3 different deformities are characterized by adduction of the forefoot: talipes varus (Figure 183-6), in which the entire foot is inverted and the forefoot is adducted; metatarsus varus (Figure 183-7), in which the forefoot is inverted and adducted while the hind foot and heel are in the normal position; and metatarsus adductus (Figure 183-8), in which the only finding is adduction of the metatarsals at the tarsometatarsal joints. The combined incidence of these 3 forefoot adductive deformities is in the neighborhood of 1 per 100 live births (the most frequent musculoskeletal congenital malformation), with metatarsus adductus being the most common and talipes varus the least common.

Talipes varus and metatarsus varus have been considered lesser degrees of clubfoot and are fixed deformities of the foot that require early treatment. The medial border of the foot is concave, with a widening of the space between the 1st and 2nd toes and a high medial longitudinal arch. The lateral border of the foot is convex, and the base of the 5th metatarsal bone is prominent.

Figure 183-6 Bilateral talipes varus. The entire foot is twisted inward on its longitudinal axis, and the forefoot is adducted. (Tachdjian MO. Pediatric Orthopaedics. 2nd ed. Philadelphia, PA: WB Saunders; 1990. Copyright © 1990, Elsevier, with permission.)

Figure 183-7 Bilateral metatarsus varus. The forefoot is inverted and adducted, the great toe is widely separated from the second toe, and the lateral border of the foot is convex. The hindfoot is in a neutral position. (Sharrard WJW. Paediatric Orthopaedics and Fractures. 2nd ed. Oxford, NY: Blackwell Scientific; 1979. Reprinted by permission of Blackwell Publishing Ltd.)

Figure 183-8 Metatarsus adductus. The forefoot is adducted but not inverted. (Ferguson AB. Orthopedic Surgery in Infancy and Childhood. 4th ed. Baltimore, MD: Williams & Wilkins; 1981. Reprinted by permission of Lippincott Williams & Wilkins.)