[Skewfoot ]

The deformity, congenital metatarsus adductus, has been given different names in various countries by different authors. In addition, there are both mild and severe forms, and some authors subdivide the deformity by degree. The severe form is also called skewfoot or serpentine foot, but to us these terms only appear to represent differences in degree. With regard to etiology, it has been found that a narrow uterus, for various reasons, seems to play a role, and that the foot and lower leg is rotated internally. If not treated early, the internal rotation of the lower leg increases and is frequently misdiagnosed. Conservative treatment consists, first of all, of plaster casts, with the lower leg rotated externally, the forefoot abducted, and the hindfoot supinated. The deformity itself consists of the adducted metatarsal bones and--to different degrees--a subluxation of the Chopart joint. In extreme cases there is a vertical medially directed talus and the navicular bone is displaced laterally. Different surgical procedures are discussed. We have found that the tendon of the anterior tibial muscle inserts more distally than usual at the base of the first metatarsal bone and winds itself towards the plantar side. For treatment, it is transferred to the dorsal side of the first cuneiform bone. In one child with severe serpentine feet, the posterior tibial muscle did not insert at the navicular bone but only inserted at the plantar side of the middle part of the foot. During the operation, the Chopart joint is reduced and a part of the posterior tibial tendon is led to the navicular bone.