- 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 and Skewfoot.