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
Management pathway
- Asymptomatic: observe.
- Symptomatic: surgical treatment.
- Medial sliding calcaneal osteotomy: corrects hindfoot valgus.
- Lateral shortening or medial column lengthening: corrects forefoot adduction.