Skewfoot (forefoot adduction with heel valgus)

Skewfoot, a malalignment of tarsal and metatarsal bones, is recognized clinically by forefoot adduction and heel valgus. Synonyms include S-shaped foot, serpentine foot, and Z-foot deformity. Skewfoot must be differentiated from metatarsus adductus, metatarsus varus, and metatarsus adductovarus. Only 50 cases have been reported, and only two primary articles have been published in the English literature. Four patients who were treated at the Mayo Clinic are described. The ages of the patients at the time of presentation ranged from 6 months to 3 years. Three patients underwent operation. Because the natural history of skewfoot is unknown and pain is infrequent, treatment alternatives must be carefully considered. If operation is undertaken, realignment of the tarsal bones should be supplemented with hindfoot bone stabilization.