Metatarsus Adductus

Structural and Postural Conditions· Also known as: metatarsus varus, forefoot adductus, bean-shaped footUpdated Nov 2026

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, November 2026

At a Glance

Metatarsus adductus is a foot shape in which the front half of the foot turns inward, while the heel and ankle stay normal. It is the most common foot difference seen at birth. It may affect one foot or both. Most babies have a flexible foot that can be gently guided back toward a normal position. In most cases the foot straightens by itself over the first few years, often with no treatment. Stiffer feet are treated differently.

What is it?

In metatarsus adductus, the front half of the foot bends inward. The bend happens at a joint around the middle of the foot (the tarsometatarsal joint). The heel and ankle line up normally. From above or below, the foot looks C-shaped, or a bit like a bean. That is why it is sometimes called bean-shaped foot.

It can affect one foot or both. It is the most common foot difference present at birth.

Feet are described by how easily the front half can be moved. A flexible foot can be moved past the straight position with gentle pressure. A semi-flexible foot can be moved only to the straight position. A rigid foot can't be moved to the straight position. Most babies have the flexible type.

Who does it affect?

It is seen in newborns and is the most common foot condition in babies under 1 year. Estimates of how often it happens vary: 1 to 2 in every 1000 births, or 0.1 to 1 per cent of births. In the past it was reported more often in girls.

There are no clear risk factors beyond the way the baby lay in the womb. It isn't yet known whether things like a first pregnancy or a family history make it more likely.

Signs and symptoms

The main sign is the inward curve of the front of the foot. The outer edge of the foot may curve like a bean. There may also be a gap between the big toe and the second toe. A parent or midwife may notice it soon after birth, or it may be found at the newborn check.

Very mild cases can be missed until a child starts walking. Then the toes may point in. A flexible foot is typically painless, even if it lasts longer than expected.

Some signs can point to something more than a flexible foot:

A foot that is rigid and can't be brought to the straight position can mean the shape is fixed in the bones, not just a matter of position.
A foot that is stiff, painful, or not improving after a few months can also mean a fixed shape.
A hip check that isn't normal can point to hip dysplasia (a hip joint that hasn't formed properly). This can occur alongside metatarsus adductus, or on its own.
A foot with ankle involvement, where the ankle is pointed down (called equinus), is more like clubfoot than metatarsus adductus.
A foot where the heel tilts outward while the front stays turned in, forming a Z shape, can be skewfoot. This can follow adductus that has gone on for a long time without enough treatment.

What causes it?

The most commonly reported cause is the baby's position in the womb. If space is cramped, the foot can be held in a curved shape. The shape is then there from birth.

It can be positional (flexible) or structural (fixed). Hip dysplasia can occur alongside it, which is one reason a baby's hips are looked at carefully when a foot difference is found.

How is it diagnosed?

Diagnosis is by examination. Often a midwife or another health professional spots it when looking at the baby's feet after birth.

The key step is judging how flexible the front of the foot is. Your podiatrist, or another practitioner, gently moves the foot and sees how far it goes. They may also use the heel bisector line: an imaginary line through the middle of the heel and out across the foot. In a normally shaped foot, it passes through the second toe. The more it shifts toward the outer toes, the more severe the curve.

The whole leg is looked at too: hips, knees, shins and feet. Gait (the way your child walks) is also checked. Some babies also have a hip ultrasound scan at about six weeks old.

Other conditions can look similar:

Clubfoot involves the ankle as well, with the foot pointed down. Metatarsus adductus does not.
Internal tibial torsion is a twisted shin bone. The foot turns in, but the kneecaps still point forwards.
Skewfoot is described under Signs and symptoms.

Treatment

Treatment depends on how stiff and how severe the foot is. Mild to moderate cases can be managed without surgery.

Looking after it at home

For a flexible foot, the usual approach is watching and waiting, with reassurance for the family. The foot is followed over the first months to see it change. Watching and waiting is the best-supported approach for flexible feet.

Gentle stretching of the foot is also used for milder cases. How well stretching works, and how much is best, isn't yet clear.

Sleeping on the tummy and sitting in the W position (knees bent, feet out beside the hips) do not make it worse. Those claims are myths.

Treatment from your podiatrist

Your podiatrist may check how flexible the foot is and record whether it is flexible, semi-flexible or rigid. They may check your child's hips, knees and walking too. Then they can follow how the foot changes. They may show you how to do gentle stretches. Your podiatrist may also explain which signs would suggest the foot needs further care.

Other options

For rigid, severe or non-improving feet, the usual next step is serial casting. This means a series of casts, each moving the foot a little closer to the right position. Casts are usually changed weekly. A below-knee plaster cast has corrected moderate or severe stiff feet in 6 to 8 weeks. A child may be seen by a children's bone and joint specialist (a paediatric orthopaedic specialist) in these cases.

Special shoes, shoe inserts (orthotics), braces and physical therapy are kept for stubborn cases. There is little to show that orthotics or braces help.

Recovery

The outlook is generally good. Flexible feet often start to correct within the first 3 months. They improve by 6 months, and most have settled by 12 months. About 90 per cent of cases correct by 1 year.

Some sources give longer time frames. Many feet settle over the first two to three years, or by around age three. By age four, 95 per cent of cases have cleared without treatment. By age 2, a flexible foot is expected to have settled. If it lingers, it is typically painless.

Stiffer or more severe feet are less likely to settle on their own. A severe curve that doesn't go away can lead to bunions or hammertoes later in life. In rare cases, adductus that is never corrected can lead to a Z-shaped foot. Beyond stiffness, it isn't yet clear what predicts which feet will linger.

Preventing it

Because it is linked to the baby's position in the womb, there is no known way to prevent it. Whether anything stops it coming back after casting isn't yet clear.

Frequently asked questions

Is metatarsus adductus the same as clubfoot?

No. In clubfoot the ankle is involved too, and the foot points down (called equinus). In metatarsus adductus, only the front half of the foot turns in, and the heel and ankle sit normally.

Does it cause pain?

A flexible foot is typically painless, even if it lasts past the age when most settle. Pain is not a usual part of it, and pain in a foot with this shape can point to a more fixed problem.

Did something I did cause it?

Almost certainly not. It is linked to the way the baby lay in the womb, where space can be tight. The foot shape is usually there from birth.

How is it different from in-toeing?

In-toeing is when the toes point in as a child walks. It can come from the front of the foot, as here, or from a twisted shin bone (internal tibial torsion). With a twisted shin, the kneecaps still point forwards.