What is the cause of hallux varus (inward deviation of the great toe)?

From the Guidelines

Toes pointing towards the midline, also known as in-toeing or pigeon-toed gait, is typically a normal developmental variation that usually resolves on its own without treatment by age 8-10. This condition can stem from three main causes: metatarsus adductus (curved foot), internal tibial torsion (twisted shin bone), or femoral anteversion (inward rotation of the thigh bone) [not directly discussed in 1]. If a child's in-toeing persists beyond age 8, causes pain, affects function, or worsens over time, consultation with a pediatric orthopedist is recommended.

Important Considerations

• The provided study 1 discusses Achilles tendinopathy, which is not directly related to in-toeing or pigeon-toed gait, but it does highlight the importance of anatomic deformities such as forefoot and heel varus and excessive pes planus or foot pronation in tendon problems.
• In-toeing typically doesn't interfere with a child's ability to learn to walk or participate in physical activities, and most children do not require intervention.
• Treatment options may include observation, stretching exercises, special shoes or braces in some cases, and rarely surgery for severe cases that don't improve, but these should be guided by a pediatric orthopedist.

Key Takeaways

• Parents should avoid "corrective" shoes or having children sit in specific positions as these interventions have not been proven effective.
• The focus should be on monitoring the child's condition and seeking medical attention if it persists or causes problems, rather than attempting to correct it with unproven methods.
• As the study 1 suggests for Achilles tendinopathy, anatomic misalignment can be treated with shoe orthotics to correct overpronation or pes planus problems, but this is not directly applicable to in-toeing.

From the Research

Toes Towards Midline

There is no direct information available in the provided studies regarding the specific topic of "toes towards midline". However, the studies do discuss the management of spasticity in children with cerebral palsy, which may be related to the topic.

• The studies suggest that botulinum toxin therapy is an effective treatment for focal spasticity, and it can be used in combination with other treatments such as physical and occupational therapy, and neuromuscular electrical stimulation 2, 3, 4, 5.
• The use of intrathecal baclofen infusion in combination with botulinum toxin therapy has also been shown to be effective in managing spasticity in children with cerebral palsy 6.
• The studies highlight the importance of a multidisciplinary approach to managing spasticity, including the use of medications, physical therapy, and other interventions 2, 3, 5.
• The evidence suggests that botulinum toxin therapy can improve muscle tone, motion, and pain in children with cerebral palsy, and it can be used to treat localized spasticity 3, 4, 5.

Some of the key findings from the studies include:

• Botulinum toxin therapy can reduce spasticity and improve passive and active mobility in children with cerebral palsy 3, 5.
• The combination of botulinum toxin therapy and intrathecal baclofen infusion can improve spasticity, pain, quality of life, and self-care in children with cerebral palsy 6.
• The use of botulinum toxin therapy in combination with physical and occupational therapy, and neuromuscular electrical stimulation can improve hand function in children with cerebral palsy 4.