Metatarsus adductus can be associated with hip dysplasia (2% of cases); therefore a thorough hip evaluation is essential. A history of a crowded intrauterine environment, such as uterine fibroids, bicornate uterus, multiple gestation or oligohydramnios is often associated with metatarsus adductus.

The severity of metatarsus adductus may be graded by the heel bisector method. Normally, a line bisecting the heel falls between the 2nd and 3rd toes. The metatarsus adductus is considered mild if line falls through the 3rd toe, moderate if between the 3rd and the 4th toes, and severe if between the 4th and 5th toes. Flexibility of the forefoot should be assessed. A flexible foot might be defined as one in which the 2nd toe can be easily brought in line with or past the heel bisector.

In babies with limited flexibility of the forefoot, radiographic examination is necessary to rule out talipes varus and metatarsus varus.

When evaluating metatarsus adductus in the primary care physician's office, placing the child in a standing position on a copy machine and taking a photocopy of the soles of the feet is an easy way to assess the heel bisector position. Although it is somewhat subjective, this low-cost, no-risk method allows for tracking of the progression or improvement of the condition over time.