It is most common in infants and children under two years of age[1] and, when not the result of simple muscle weakness,[2] normally arises from underlying conditions, such as a twisted shin bone or an excessive anteversion (femoral head is more than 15° from the angle of torsion) resulting in the twisting of the thigh bone when the front part of a person's foot is turned in.

[7] Signs and Symptoms[5] The tibia or lower leg slightly or severely twists inward when walking or standing.

[6][5] Signs and Symptoms[5] The neck of the femur is angled forward compared to the rest of the bone, causing a compensatory internal rotation of the leg.

[8] As a result, all structures downstream of the hip including the thigh, knee, and foot will turn in toward mid-line.

[6] Surgical Management: Most cases of metatarsus adductus that does not resolve is asymptomatic in adulthood and does not require surgery.

[6] Occasionally, persistent rigid metatarsus adductus can produce difficulty and significant pain associated with inability to find accommodating footwear.

[5] Due to the high failure rate of capsulotomy and tendon transfer it is generally avoided.

[6][5] Osteotomy (cutting of bone) and realignment of the medial cuneiform, cuboid, or second through fourth metatarsal the safer and most effective surgery in patients over the age of 3 years old with residual rigid metatarsus adductus.

[5][6]  This rotational limb variant does not increase risk for functional disability or higher rates of arthritis if unresolved.

Treatment modalities such as bracing, physical therapy, and sitting restrictions have not demonstrated any significant impact on the natural history of femoral anteversion.

[6] Surgical management: Operative treatment is reserved for children with significant functional or cosmetic difficulties due to residual femoral anteversion greater than 50 degrees or internal hip rotation greater than 80 degrees after age 8.