Skewfoot

Skewfoot, also known as serpentine foot or Z-foot, is a complex congenital foot deformity that combines features of forefoot adduction and hindfoot valgus. It is sometimes considered a combination of metatarsus adductus (curving inward of the forefoot) and hindfoot valgus (outward angulation of the heel).

Aetiology

  • Condition Type: Uncommon, complex
  • Deformity: Forefoot adduction and hindfoot valgus
  • Cause: Considered a packaging disorder

Key Characteristics:

  • Forefoot Adduction: The front part of the foot curves inward.
  • Hindfoot Valgus: The heel is angled outward, which causes the arch of the foot to flatten.
  • Midfoot Abduction: Often, the middle part of the foot appears to bend outward to compensate for the positioning of the forefoot and hindfoot.

Symptoms:

  • Foot pain when weight-bearing, especially in more severe cases.
  • Difficulty finding comfortable footwear due to the foot’s shape.
  • Visible foot deformity, where the foot may appear Z-shaped or serpentine in alignment.

Prognosis:

With treatment, the goal is to realign the foot to improve function and reduce pain. However, because it’s a complex deformity, treatment outcomes vary, and follow-up care is often necessary.

Management

Observation

  • Most cases are asymptomatic and can be observed.

Surgical Treatment

  • Non-operative treatment is generally unsuccessful for symptomatic cases.
  • Surgical approach involves a combination of osteotomies:
    • Medial sliding calcaneal osteotomy: Corrects hindfoot valgus
    • Lateral shortening or medial column lengthening osteotomy: Addresses forefoot adduction

flowchart TD
    A[Skewfoot] --> B{Symptomatic?}
    B -- No --> C[Observe]
    B -- Yes --> D[Surgical Treatment]
    D --> E[Medial Sliding Calcaneal Osteotomy<br>Corrects Valgus]
    D --> F[Lateral Shortening or <br>Medial Column Lengthening<br>Corrects Adduction]

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