SKEWFOOT
Sometimes called “Z” or serpentine foot, skewfoot affects the formation and growth of the bones in the foot. Hooking inward, the foot has a C-shaped appearance. Skewfoot doctors may not diagnose the condition until the child reaches the age of 4 and 6 years old. At six, the bones of the foot have matured, and X-rays and MRI scans can clearly see them.
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Skewfoot
The term “skewfoot” or “skew foot” refers to a congenital birth abnormality that occurs during the development of the baby’s foot bones. Serpentine Foot and Z Foot are other names for it. Also referred to as Metatarsus Adductus, it refers to a severe type of foot malformation. The infant’s foot appears “C” shaped in this malformation. Skewfoot is a congenital birth defect, meaning that it is present at birth. It closely resembles metatarsus adductus, in which there is a noticeable “bend” in the middle of the foot and the forefoot curves inward. However, the key difference with skewfoot is that the hindfoot is also misaligned, creating a distinctive “C” or even “Z” shape—hence why it’s sometimes called “Z-foot” or serpentine foot. In fact, some physicians consider skewfoot a particularly severe form of metatarsus adductus.
When the child can walk, doctors will recommend specially designed shoes and arduous stretching exercises. However, the shoes and exercises may not always fix the deformity.
Doctors report that Skewfoot or Serpentine Foot is a difficult condition to diagnose. This problem occurs because the baby’s bones are not sufficiently formed. Thus, when X-rays of the affected foot are taken, it essentially comes out clear. Because of this, doctors find it difficult to precisely estimate the shape of the foot’s bones at that stage. However, by the age of 6, the bone has fully formed, and the Skewfoot appears clearly on an X-ray.
A Flexible Start, a Rigid Turn
The condition remains rather flexible through a child’s development, until typically around the age of six, when it can become more rigid. This is when further troubles can begin to develop. Before this age, the flexible nature of the bones and soft tissues can sometimes mask the true extent of the deformity, making early detection difficult. As the foot matures, rigidity increases, which may then lead to discomfort, abnormal gait, or difficulty in fitting shoes properly.
QUESTIONS AND ANSWERS
What causes skewfoot in children?
Skewfoot refers to a common condition in newborns and infants and some believe the positioning of the feet in the womb causes the condition. It usually resolves on its own as the child grows and starts bearing weight on the feet. In some cases, skewfoot may persist or develop later in childhood due to other factors such as muscle imbalances or neurological conditions. It’s essential for the doctor to assess the specific cause in each individual case to determine the appropriate course of action.
What do Doctors recommend to treat skewfoot?
In many cases, mild skewfoot corrects itself as the child begins to walk and put weight on the feet. For persistent or more severe cases, the doctor may recommend exercises, stretches, or physical therapy to address muscle imbalances and improve foot alignment. In rare instances, if the condition appears severe and doesn’t respond to conservative measures, doctors may recommend orthopedic devices or braces. Doctors recommend surgery in very rare and severe cases.
Will skewfoot affect my child's ability to walk or participate in sports, and what can we do to support their development?
In most cases, skewfoot does not significantly impact a child’s ability to walk or participate in sports. Early intervention, if necessary, can help address any potential issues and promote normal development. The doctor may provide guidance on activities, exercises, and footwear that can support the child’s foot development. Regular follow-up appointments will allow the doctor to monitor the child’s progress and make any adjustments to the treatment plan as needed.
Parents should consult with their child’s healthcare provider for personalized advice and guidance regarding skewfoot. The doctor will assess the specific circumstances of the child’s condition and provide recommendations tailored to their individual needs and development.
The doctors at the Medical City Children’s Orthopedics and Spine Specialists Practice only treat children. As such, our doctors have become experts in children’s medical conditions. From mild to the most complex, we are here for your child.
What Causes Skewfoot Or Serpentine Foot?
Skewfoot appears common in young children and gets better as they age. In adults, incorrect foot stress or unstable shoes are common causes. However, inflammatory conditions or injuries may also contribute to this condition. As with many congenital birth defects, skewfoot can also arise from inherited traits that cause instability or misalignment in the developing foot. It’s important to note that there is nothing parents could have done to prevent this condition; it simply occurs during development, and parents are not to blame.
Sometimes, a child may be born with only a portion of the misalignment, with the rest developing later as the body adjusts weight and posture to compensate. Again, neither the child nor the parents is at fault if skewfoot progresses or changes over time.
The precise etiology of Skewfoot or Serpentine Foot has been the subject of several conflicting and varying observations. Skewfoot or Serpentine Foot has been seen after extended casting for the treatment of Metatarsus Adductus.
Recognizing Skewfoot: Symptoms and Bone Changes
In addition to the foot’s C-shaped appearance, several specific features and symptoms may point to skewfoot, including:
- Abnormal gait: Children may walk differently, sometimes with a noticeable inward turn of the foot.
- Triangular cuneiform bone: The cuneiform bone in the arch may appear triangular instead of the normal square, often seen on imaging.
- Misaligned bones: The ankle bone (talus), heel bone (calcaneus), and navicular may appear out of alignment relative to each other.
- Inward-shifted metatarsals: The five metatarsal bones at the base of the toes can point inward rather than straight ahead.
- Associated discomfort: Over time, children and adults with skewfoot may incur a greater risk for heel pain, knee pain, hammertoes, and similar conditions due to abnormal gait and added strain on the lower limbs.
Diagnosing Skewfoot Or Serpentine Foot
When a child is younger than six years old, the bones of the foot have not fully developed, making it difficult to diagnose Skewfoot or Serpentine Foot. However, once the child reaches about six years of age, the bones of the foot have fully developed, making the diagnosis of Skewfoot or Serpentine Foot with X-rays or MRI studies possible. Standing AP and lateral X-rays of the foot are taken to identify Skewfoot or Serpentine Foot. The AP view will display a mixture of adduction of the metatarsals and adduction of the midtarsal joints in this disease, giving the foot a Z-shaped form. Doctors can diagnose Skewfoot or Serpentine Foot if the lateral view reveals plantar flexion of the talus.
The Treatment of Skewfoot Or Serpentine Foot
A child’s flat-valgus foot appears, in some ways, completely normal and typically goes away with time. Therefore, even if they do not show any indications of deformity, children should wear comfortable, flexible shoes. Parents should ensure that they do not cramp their child’s feet and walk barefoot (as adults, too). Doctors advise actively engaging in foot gymnastics and getting orthopedic inlays via a prescription.
How stiff the foot appears when the doctor tries to straighten it will determine the course of treatment. Treatment will not occur if the foot appears extremely flexible and simple to straighten or shift in the opposite way. We’ll keep a careful eye on your kid for a while. As most kids use their feet normally, the issue resolves itself. They don’t require any more medical attention. If the issue persists or if your child’s foot appears inflexible, additional treatments will occur.
Additional Treatments
- Exercises for stretching. If the foot can move into a normal posture with ease, these are performed. These exercises can occur at home with the help of the family.
- Your youngster might have to spend the majority of the day wearing a splint or unique footwear known as reverse-last shoes. The foot maintains the proper posture with these shoes.
- Rarely will your youngster require a cast on their foot or leg. Before your child becomes eight months old, casting will occur. Doctors will replace the cases every two weeks.
- Although uncommon, doctors may recommend surgery. The majority of the time, your doctor will postpone the procedure until your child is 4 to 6 years old.
More severe abnormalities will require a pediatric orthopedic surgeon. For a while, the child will wear extra-wide shoes with comfort inserts to manage this issue. However, if the child reaches the age of four and begins to exhibit severe signs of pain and trouble walking, your doctor may recommend surgery. Skewfoot or Serpentine Foot essentially consists of three sections. The metatarsal bones are angled inward in the initial section. The first cuneiform bone has an aberrant triangle shape, which contributes to the foot moving inwards in a second way. The misalignment of the navicular, heel, and ankle bones makes up the third component.
Surgery
The most popular treatment for this condition is surgery. To maintain the bones in place after surgery, casts or pins are used to hold the bones in place. The majority of youngsters who receive casts cannot walk for around six weeks after the treatment. The child may subsequently have a walking cast for an additional month after the second X-ray assesses the healing. The primary goal of casting and surgery is to ensure that the child’s foot is flexible enough for them to walk, function normally, and wear regular shoes. However, in order to achieve this goal, it is crucial to ensure that this deformity is kept at bay. Regular checkups will ensure the surgery heals properly, making sure that the bones are growing normally.
Although the kid may live a normal life free of any symptoms, nonoperative therapy for Skewfoot or Serpentine Foot is typically useless since it does not alter the look of the foot. Serial casting and strenuous stretching exercises are typical nonoperative treatments.
Conclusion
Musculoskeletal disorders are successfully treated by orthopedic doctors and surgeons at Medical City Children’s Orthopedics and Spine Specialists. When patients go to the Medical City Children’s Orthopedics and Spine Specialists offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX, they have the Specialists to treat complicated or uncommon illnesses. Finally, parents can bring their child to the Medical City Children’s Orthopedics and Spine Specialists independently or after receiving a recommendation from their physician, an orthopedic surgeon, or another expert. Furthermore, our doctors collaborate with other medical professionals to choose the best course of action for your child’s particular needs.
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Citation: National Institute of Health – Skewfoot
The medical content on this page has been carefully reviewed and approved for accuracy by the Medical City Children’s Orthopedics and Spine Specialists qualified healthcare professionals, including our board-certified physicians and Physician Assistants. Our team ensures that all information reflects the latest evidence-based practices and meets rigorous standards of medical accuracy, with oversight from our expert spine doctors to guarantee reliability for our patients.
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