title: Resistant metatarsus adductus: prospective randomized trial of casting versus orthosis.
abstract: BACKGROUND
  Metatarsus adductus is a common pediatric foot deformity related to intrauterine molding. It is usually a mild deformity that responds well to simple observation or minimal treatment with a home program of stretching. Resistant cases may need a more aggressive approach such as serial casting or special bracing to avoid the need for surgical intervention. We compared clinical outcomes using serial casting with orthoses for resistant metatarsus adductus.
  
  
  METHODS
  We prospectively treated 27 infants (43 feet) between the ages 3 and 9 months who failed home stretching treatment. Patients were randomized to either serial plaster casting or Bebax orthoses. Footprints and simulated weight-bearing anteroposterior and lateral view radiographs were made at entry and follow-up.
  
  
  RESULTS
  There was no statistical difference between casting and Bebax for the following parameters: age at study entry, length of treatment, number of clinic visits, follow-up, and follow-up maintenance treatments. Both groups showed improvement in footprint and radiographic measurements post-treatment, without worsening of heel valgus. The Bebax group had greater improvement in the footprint heel bisector measurement than the casting group. The Bebax treatment requires more active parental cooperation. A simulated cost analysis of materials and office visit charges, however, revealed that Bebax treatment was significantly less expensive, about half the cost of casting.
  
  
  CONCLUSIONS
  Because of the cost savings and virtually identical clinical results, we recommend the Bebax orthosis for resistant metatarsus in pre-walking infants with parents who are compliant. Other considerations include specific insurance plans, which may pay for casts but not orthoses.
authors.affiliation: International Center for Limb Lengthening, The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, USA. Electronic address: jherzenberg@lifebridgehealth.org.
authors.forename: John E
authors.initials: JE
authors.lastname: Herzenberg
authors.affiliation: Endoklinik Hamburg, Holstenstraße 2, 22767 Hamburg, Germany.. Electronic address: rolf-burghardt@web.de.
authors.forename: Rolf D
authors.initials: RD
authors.lastname: Burghardt
mesh_terms: D002370:Casts, Surgical; D004867:Equipment Design; D005500:Follow-Up Studies; D005532:Foot Deformities, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D061826:Foot Orthoses; D006801:Humans; D007223:Infant; D008684:Metatarsus / Q000002:abnormalities* / Q000503:physiopathology; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome