Skew Foot

What is skew foot?

Skew foot, or skewfoot, is a condition that children are born with. It changes how bones form in your child’s feet. The bones grow in ways that aren’t typical, causing their feet to take on a “Z” or snake-like (serpentine) shape. Some people refer to skew foot as Z foot or serpentine foot.

Anyone can get skew foot, a congenital condition in babies. It’s a type of birth defect.

How will skew foot affect my child’s feet?

In a child with skew foot, bones on the inner (medial) side of your child’s feet curve sharply inward, while bones on the outer (lateral) side of their feet curve like a circle. Bones in their heel and ankle don’t line up correctly, creating a “Z” shape in the foot.

Children with skew foot may also have a bump in a joint (Lisfranc joint) on the top of their feet.

How common is skew foot?

Skew foot is rare. The condition is a type of flat feet. Healthcare providers also consider skew foot a type of metatarsus adductus, a foot condition where your foot turns inward. Metatarsus adductus occurs between 1 in 100 to 1 in 5,000 births.

What causes skew foot?

Skew foot is a birth defect. Healthcare providers aren’t sure why this condition occurs at birth.

Babies born with skew foot have a difference in one of their foot’s 26 bones: The cuneiform bone, found in the foot’s arch, is typically square. In children with skew foot, this bone is a triangle shape.

What are the symptoms of skew foot?

Children with skew foot typically have:

• Misaligned bones in their heel and ankle.
• Visible turning inward of their metatarsal bones.
• Gait (walking) issues in older children.

How do healthcare providers diagnose skew foot?

You or your provider may notice your baby’s feet seem misaligned or misshapen. Sometimes, providers don’t diagnose skew foot until a child is older, around age 6. The condition can be challenging to diagnose in younger children, as their feet are more flexible.

To diagnose skew foot, healthcare providers check your child’s feet as part of a physical examination. They look at the shape of your child’s feet and how your child walks (if they’re old enough to walk).

What tests do healthcare providers use to diagnose skew foot?

To confirm a diagnosis of skew foot, providers use imaging tests, including:

• MRI.
• X-ray.

How do healthcare providers treat skew foot?

Skew foot treatment depends on how old your child is at diagnosis. In babies and very young children, treatment may include nonsurgical therapies like:

• Casts and splints.
• Physical therapy (including stretching).
• Special shoes that hold feet in the correct position.

Your child’s healthcare provider will monitor how their feet are developing and recommend treatments to correct skew foot.

Will my child need surgery?

Your provider may recommend surgery if:

• Nonsurgical therapies don’t work.
• Your child is older than 6, and their feet are rigid.
• Your child is in a lot of pain or has difficulty walking.

What happens during surgery for skew foot?

During surgery, healthcare providers may remove pieces of bone (osteotomy). They may also place pins to line up bones correctly and tighten any loose ligaments.

What happens after surgery?

Your child will need to wear a cast and avoid walking while their bones heal after surgery.

How long does it take to recover?

Most children heal from skew foot surgery in about six weeks. Once the initial healing is complete, your child may need to wear a support appliance like a brace or walking cast while the bones continue to heal.

Your healthcare provider may also refer you to a physical therapist. They can help retrain your muscles so you can stand and walk properly.

Can I prevent my child from developing skew foot?

Skew foot is a type of birth defect. There isn’t anything you can do to prevent it, and nothing you did caused it.

What can I expect if my child has skew foot?

If your child has skew foot, a healthcare provider will regularly monitor their feet as they grow and develop. Your provider may recommend different exercises or other treatments as your child’s feet change.

How long will my child have skew foot?

Healthcare providers treat most children with skew foot successfully. After treatment, children are usually able to walk normally and without pain.

Are there long-term effects?

With treatment, most children with skew foot don’t have any long-term effects from the condition. Some adults who were born with skew foot but didn’t receive appropriate treatment develop bunions or arthritis.

How do I take care of my child?

Follow your healthcare provider’s instructions carefully. Make sure your child wears any necessary splints, casts or shoes for the instructed amount of time. If your provider has given you stretching or other exercises to do with your child, be sure to do them as recommended.

A note from Cleveland Clinic

Skew foot (skewfoot), also called serpentine foot, is a congenital condition that causes changes to the shape of your child’s feet. While there isn’t a way to prevent skew foot, your healthcare provider will monitor your child’s growth and development and recommend treatments to heal skew foot.