- Parents may notice in toeing if child presents after walking age
- Forefoot is adducted relative to the hindfoot
- Viewed from the plantar surface the sole of the foot appears like a bean
- Lateral border of the foot is convex
- Medial border of the foot is concave
- Base of the 5th metatarsal may be more prominent than normal
- Space between the 1st and 2nd toe is also increased
- Ankle and sub-talar joints’ movement is normal
- It is important to undertake a thorough clinical assessment to rule out plagiocephaly, torticollis and DDH
- It is also important to assess lower limb rotational profile to rule out other causes of internal rotation of the foot
- However MA may co-exist with a degree of Internal tibial torsion
- It is important to take a full history as MA can present as a sequel following treatment for previous CTEV
![4.1.1.png 4.1.1.png](http://postgraduateorthopaedics.co.uk/Images//_Topic/1402/4.1.1.png)
Clinical photograph of metatarsus adductus.
![4.1.2.png 4.1.2.png](http://postgraduateorthopaedics.co.uk/Images//_Topic/1402/4.1.2.png)
Hind foot is mobile and there is no equinus of the heel which is an important differentiating sign form clubfoot.
![4.1.3.png 4.1.3.png](http://postgraduateorthopaedics.co.uk/Images//_Topic/1402/4.1.3.png)
Metatarsus adductus can be part of residual club foot deformity (look for the foot size, hind foot deformity and any surgical scarring).