If you are able to stand and walk, or even run without problems, you should be grateful that your lower limbs are working perfectly. Similar to many other health conditions affecting the body, some people may have lower limbs that seem different from others. The differences may even result in difficulty for patients to live normally like other people would. In this DoctorOnCall’s article, we will learn about skewfoot, a condition associated with defects to the foot.
As the name implies, skewfoot is a condition where the foot has a slant that is considered abnormal. Skewfoot is a rare condition of the foot hooking inward. It is known as a type of flat foot that is specifically described as Z foot or serpentine foot. Flat foot is a condition where the feet has minimal to no foot arch, that leads to the middle part of the foot touching the ground. Skewfoot is a rare condition considering it only affects 0.5% of the general paediatric population. It is so rare that the exact number of those affected is unknown.
Skewfoot is commonly known to be a congenital condition. This means that the condition exists at birth. Even so, the exact cause behind the condition is not well understood. Theory muscle imbalance has been said to play a role in developing this condition. Beside being a congenital condition, skewfoot in some cases may be caused by other conditions that are acquired such as metatarsus adductus. Metatarsus adductus is a foot deformity that causes the frontside of half the foot to turn inward. Metatarsus adductus that goes untreated or undertreated has been shown to be causing skewfoot deformity. There are 4 types of skewfoot which are idiopathic congenital skewfoot, congenital skewfoot associated with syndromes such as osteogenesis imperfecta, skewfoot secondary to neurological condition such as cerebral palsy and iatrogenic skewfoot such as after metatarsus adductus.
Skewfoot may not be diagnosed until the child is around the age of 6. This is because at this age the shape of the foot has been better determined despite it still growing. Symptoms that should be aware of in skewfoot is the abnormal walk, the five-metatarsal bone (long bones found between bones of the toes and tarsal bone) of the foot turned inward and ankle bone or heel bone seem out of place. In simple words, a patient will present in-toeing, a condition where the feet point inward when walking.
It can be difficult to diagnose skewfoot in children as the bone is still growing and the exact foot shape is not fixed until the age of 6. However, it is best for parents to get their children checked if there are walking problems by the age of 2, specifically if the child is not walking at all by the 18 months and not walking steadily by the age of 2. Diagnosis is usually made with medical history, physical examination and imaging test. Medical history will include family history to identify if there are possible causes leading to the skewfoot such as syndrome or neurological conditions. Physical examination will focus on the feet shape, structure and function. Imaging tests such x-ray is usually done to confirm the structure affected. CT scan and MRI may be done for planning treatment.
Treatment in children with skewfoot depends on the severity of the deformities and the age of the patient at the time they are diagnosed. Conservative management such as casting is typically given initially. Surgery is usually done in severe cases and after the age of 6 when there is the need to correct the foot. Surgery is usually done in multiple sessions. It is worth noting that casting itself is considered ineffective in changing the shape of the foot to normal but patients are guaranteed to be free from symptoms and the feet able to function well.
We may know more about skewfoot in children but what about skewfoot in adults? For adults, it is recommended to ask for orthopaedic inlays and to take part in foot gymnastics. However, the best way for adults that have this condition is to get checked by an orthopaedist or podiatrist as they can help to evaluate the severity of the condition and recommend the best treatment. Surgery however may be suggested in some cases where conservative approach such as casting, exercise or special shoes fails to provide relief or improve a patient’s life.
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It can be concluded that skewfoot is an abnormal foot condition belonging to the wide range of flat feet. It is commonly a congenital condition but can be acquired from other foot problems such as metatarsus adductus. It is a rare condition and diagnosing can be difficult before the child is 6 years old. Treatment is usually started with conservative approach before surgery is recommended. It is important to treat skewfoot because when it is left untreated it can cause problems in walking and foot development. It may also cause ongoing pain when the issue is not addressed.
