- 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 andSkew Foot.
Mosca V. JBJS (AM) Vol. 77-A, No 4, Apr 1995. p 500-512.
