During a well-baby examination, a newborn has adduction of the right forefoot, with normal position of the mid- and hind-foot and a convex-shaped lateral border of the foot. How should the nurse practitioner evaluate this deformity?

During a well-baby examination, a newborn has adduction of the right forefoot, with normal position of the mid- and hind-foot and a convex-shaped lateral border of the foot. How should the nurse practitioner evaluate this deformity?

• A. Observe both legs for medial and lateral rotations.
• B. Grasp the heel with one hand and abduct the forefoot with the other hand.
• C. Order anterior-posterior and lateral radiographs of both feet.
• D. Refer the infant immediately to a pediatric orthopedic specialist.

Answer: (B)

The key idea is to assess whether the inward-turned forefoot (metatarsus adductus) is flexible or rigid. In many newborns this inward orientation is benign and will improve with time, so the first step is a simple physical exam to test flexibility. The proper evaluation is to stabilize the hindfoot with one hand and gently abduct the forefoot with the other. If the forefoot can be moved outward toward a neutral position, the deformity is flexible and typically resolves on its own with normal growth, so no immediate imaging or specialty referral is needed. This maneuver directly tests the functional status of the deformity and guides management. Radiographs are not routinely indicated for a newborn with a suspected flexible metatarsus adductus, since imaging panels won’t change management and involve unnecessary radiation. Immediate referral to orthopedics is reserved for rigid deformities or those that do not improve over time or that raise concern for other conditions.

The key idea is to assess whether the inward-turned forefoot (metatarsus adductus) is flexible or rigid. In many newborns this inward orientation is benign and will improve with time, so the first step is a simple physical exam to test flexibility.

The proper evaluation is to stabilize the hindfoot with one hand and gently abduct the forefoot with the other. If the forefoot can be moved outward toward a neutral position, the deformity is flexible and typically resolves on its own with normal growth, so no immediate imaging or specialty referral is needed. This maneuver directly tests the functional status of the deformity and guides management.

Radiographs are not routinely indicated for a newborn with a suspected flexible metatarsus adductus, since imaging panels won’t change management and involve unnecessary radiation. Immediate referral to orthopedics is reserved for rigid deformities or those that do not improve over time or that raise concern for other conditions.