Screening for and treating the metatarsus adductus foot deformity

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A discussion and explanation of metatarsus adductus, why screening is important, and the UNFO brace for treatment.

In this video interview, Izak Daizade, MD, an orthopedic surgeon practicing in Israel and the inventor, president, and director of UNFO med ltd, discussed metatarsus adductus (MTA), a congenital foot deformity characterized by a sharp, inward angle of the front half of the foot.1

Image provided by Izak Daizade, MD

Image provided by Izak Daizade, MD

Daizade explained the deformity, prevalence, screening processes, and treatment options, highlighted by the Universal Neonatal Foot Orthosis (UNFO) brace.2

"The big problem that we have, is the screening problem," said Daizade. "Screening the newborn immediately after the delivery is very simple and it [takes] just a matter of a few seconds. Every pediatrician and neonatologist that check the children have to take a look. If they are not sure, make a referral to physical therapists or pediatric orthopedists."

The UNFO brace allows treatment of MTA without the need for casting or a medical procedure. The pre-molded corrective shoe was specifically designed to treat MTA in newborns and features Velcro strips.3

In severe cases, early diagnosis and treatment is important, with better outcomes reported if treatment was initiated before 9 months of age. Investigators of a 2022 study published in the Journal of Pediatrics Orthopaedics B sought to compare effectiveness of UNFO to standard serial casting in treating MTA in infants.3

From 2012 to 2019, investigators treated 147 feet (94 patients), of which 52 used the UNFO shoes and 95 used standard casting and splinting protocols. Mean full-time treatment duration was significantly shorter in the UNFO group. Effectiveness was equal to standard serial casting, though the use of UNFO increased convenience and diminished social burden, "thus providing a distinct advantage over other treatment modalities," concluded the study authors.4

"With the new concept of the UNFO therapy, it is very easy to advise it, very easy to use it, we don't need skilled [personnel] for installation or training the parents," said Daizade. "[UNFO] is like a sandle over the foot, with 6 points of pressure-correcting forces. When you stretch the Velcro and close it up, it applies the best corrective forces over the baby's foot."

Image provided by Izak Daizade, MD

Image provided by Izak Daizade, MD

In a 2021 study published in the European Journal of Pediatrics, 73 children between 4 and 11.5 months of age with moderate to severe MTA were treated with UNFO. Treatment in rigid deformity cases began when the child was first seen in the clinic, or after 5 months of age in children with moderate to severe, but flexible deformity that failed to improve spontaneously.5

The orthosis was applied for 23 hours each day. Weaning started after complete correction was achieved, with follow-up continuing until walking age. In all, 71 patients and 114 feet were followed from time of diagnosis to walking age. 102 feet were classified as severe and 12 were moderate.5

The average age at treatment start was 6.58 months (4-11.5). Fifty-six patients and 98 feet improved significantly at the end of follow-up. Eleven children and 11 feet had no change noted, and 3 feet in 3 children worsened by the end of follow-up.5

"UNFO is an effective treatment for moderate and severe MTA in children younger than10 months, with only infrequent minor side effects," concluded the study investigators.5

Image provided by Izak Daizade, MD

Image provided by Izak Daizade, MD

References:

1. Metatarsus adductus. Mount Sinai. Accessed June 19, 2024. https://www.mountsinai.org/health-library/diseases-conditions/metatarsus-adductus#:~:text=Metatarsus%20adductus%20is%20a%20foot%20deformity%20characterized%20by%20a%20sharp,bent%20inward%20at%20the%20instep.

2. Universal neonatal foot orthotics – a noval treatment of infantile metatarsus adductus. European Journal of Pediatrics. April 9, 2021. Accessed June 19, 2024. file:///private/var/folders/n0/_1zv9sn558z4fj161bpb4sd80000gp/T/com.microsoft.Outlook/Outlook%20Temp/Universal%20neonatal%20foot%20orthotics%E2%80%94a%20novel%20treatment%20of%20infantile%20metatarsus%20adductus%20_%20European%20Journal%20of%20Pediatrics%5B14%5D.html

3. UNFO Brace. UNFO med ldt. Accessed June 19, 2024. https://unfo-med.com/

4. Freedman, Daniel; Kotlarsky, Pavel; Eidelman, Mark. Novel device for nonsurgical correction of rigid forefoot adduction in children. Journal of Pediatric Orthopaedics B 31(2):p e202-e207, March 2022. | DOI: 10.1097/BPB.0000000000000878

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