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Duke Orthopaedics
presents
Wheeless' Textbook of Orthopaedics

Skew Foot



- Discussion:
    - a type of flat foot described as a z foot or serpentine foot;
    - pathoanatomy:
           - forefoot:
                  - first metatarsal lies adducted and plantar flexed on the medial cuneiform, w/ resultant marked adductus deformity of the 
                          forefoot;
           - midfoot:
                  - lies in abduction w/ lateral displacement of the navicular on the head of the talus;
                  - navicular may also lie dorsally subluxed in relation to the talus;
           - hindfoot
                  - lies in valgus w/ pronation and inward rotation of the talus, w/ lateral subluxation of the navicular on the talar head;
                  - achilles tendon is contracted;
    - diff dx:
           - metatarsus adductus:
                  - in infants it may not always be possible to different these disorders;


- Radiographs:
    - dx is confirmed by AP & lateral standing roentgenograms of foot;
    - AP view:
         - combination of abduction at mid tarsal joints & adduction of metatarsals gives foot z configuration on AP view:
         - mid-talar axis will generally be medial to base of first metatarsal;
    - lateral view:
         - shows a reduction in calcaneal pitch & plantar flexion of talus;


- Non Operative Treatment:
    - generally ineffective in changing the shape of the foot, however, many patients will remain highly functional and relatively free of 
          symptoms;
    - if casts are applied to correct the forefoot adductus component, then consider varus hindfoot molding (to avoid valgus stress on the 
          hindfoot);


- Operative Treatment:
    - should generally be avoided if possible, since there is deformity in the forefoot, midfoot, and hindfoot which essentially means that the 
           entire foot has to be reconstructed inorder to re-establish a functional relationaships;
    - delayed until after age of six years;
    - opening wedge osteotomy of the calcaneus is done to correct mid-tarsal abduction deformity and to position the sustentaculum to 
           elevate neck of the talus;
    - this is combined w/ opening wedge osteotomy of the first cuneiform to correct the forefoot adductus



Calcaneal Lengthening for Valgus Deformity of the Hindfoot.  Results in Children Who Had Severe, Symptomatic Flatfoot and Skewfoot.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, April 25, 2012 3:52 pm