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Abstract
The cavus foot is a deformity characterized by an elevated medial longitudinal arch and a hindfoot varus with plantarflexed 1st ray. The etiology of cavus foot is usually related to neuromuscular disease or idiopathic cause. Thorough clinical and radiographic evaluation is required for differentiating etiology of the cavus. Most cases of cavus foot are stable and slowly progressive deformities which can initially be managed with conservative treatment including orthoses and physical therapies. Determining whether the deformity is flexible or rigid, the apex of the deformity and any muscle imbalances in foot and ankle is important for achievement of an adequately balanced plantigrade foot. Treatment should include systematic preoperative planning for selection of appropriate procedures for maintaining a functional and flexible foot with combinations of soft-tissue release, osteotomy, tendon transfer, and arthrodesis.
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Figure 1.
This figure shows Coleman block test of right foot for assessing flexibility of hindfoot varus. By weight-bearing on a block supporting only the lateral side of the foot except 1st ray, if the hindfoot remains flexible, the hindfoot varus can be corrected by addressing the forefoot deformity alone.
Figure 2.
On standing lateral view of cavus foot, (a) talo-1st metatarsal angle (Meary’s angle), (b) calcaneal pitch angle, and (c) calcaneo-1st metatarsal angle (Hibb’s angle) can be measured.
Figure 3.
(A) The standing lateral radiograph of right foot showed a severe cavovarus deformity. Reconstruction of cavovarus foot was done with a calcaneal lateral closing wedge osteotomy, 1st metatarsal dorsiflexion osteotomy, plantar fascia release, Achilles tendon lengthening, a modified Broström operation and tibialis anterior tendon lateralization. (B) The standing lateral radiograph for 1-year follow-up after surgery showed a balanced and plantigrade foot.
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