“Sickled feet” describes a foot shape where the front part curves inward. Medically known as metatarsus adductus, this condition is observed at birth with a noticeable inward angulation of the forefoot. Unlike other foot deformities, the hindfoot (back part of the foot) generally maintains normal alignment. The inward curve gives the foot a characteristic appearance.
Identifying Sickled Feet
The foot exhibits a distinct inward curve of the forefoot relative to the heel, creating a C-shaped appearance with toes pointing inward. Metatarsus adductus describes this alignment, where the metatarsal bones (in the middle section of the foot) turn toward the body’s midline.
The front of the foot may appear slightly turned under, with the inside seeming caved in and the outside more rounded. It specifically affects the forefoot, with the ankle and heel typically remaining normal, distinguishing it from more complex deformities like clubfoot.
Underlying Causes
The precise cause of metatarsus adductus is not fully understood, but several factors contribute to its development. A primary factor is the baby’s position within the uterus; a cramped uterine environment can cause the feet to bend inward.
Breech presentations also increase the risk. A lack of sufficient amniotic fluid (oligohydramnios) is another contributing factor. A family history of the condition also suggests a genetic component.
Distinguishing Normal Variation from Concern
Many cases of metatarsus adductus are flexible, meaning the foot can be gently straightened by hand. Healthcare providers assess this flexibility by applying gentle pressure to align the forefoot with the heel. If easily corrected, the foot is flexible, and these instances often resolve spontaneously as a child grows; over 90% of cases may correct without intervention.
Some instances are more rigid, making manual straightening difficult or impossible. A rigid foot or one that doesn’t improve over time warrants closer attention. Signs of concern include persistent inward turning, especially if it affects walking or causes frequent tripping. Uneven shoe wear can also indicate an uncorrected curvature impacting gait.
Professional medical evaluation is recommended if the foot remains rigid, if the child experiences pain, or if the condition causes difficulty with mobility or balance. While many cases are harmless, a healthcare provider can differentiate between a benign variation and a condition requiring management. Early assessment can also rule out other foot conditions or associated developmental concerns, such as developmental dysplasia of the hip.
Management Approaches
Management strategies for metatarsus adductus vary by foot flexibility and child’s age. For flexible cases, especially in infants, observation is often the initial approach. Parents may be instructed on gentle stretching exercises to encourage the foot into a more typical position. These exercises stretch the forefoot’s soft tissues and are often performed during routine activities.
If the foot is rigid or doesn’t respond to stretching, serial casting may be used. This involves applying a series of plaster casts, changed every one to two weeks, to gradually stretch and reposition the foot. After casting, specialized footwear or orthotics might be prescribed to maintain corrected alignment. The primary goal of these non-surgical interventions is to straighten the forefoot and improve alignment.
Surgical intervention is rarely necessary, reserved for severe, rigid cases unresponsive to conservative treatments, usually in older children. Procedures involve reshaping foot bones for proper alignment. Following surgery, casts stabilize the foot during healing. The aim of any management approach is to ensure the foot develops normal appearance and functionality.