The adult cavus foot

Abstract

Cavovarus deformity can be classified by the severity of malalignment ranging from a subtle and flexible to a severe and fixed cavovarus deformity of the foot.In the mild cavovarus foot, careful clinical assessment is required to identify the deformity.Weight-bearing radiographs are necessary to indicate the apex of the deformity and quantify the correction required.Surgery is performed when conservative measures fail and various surgical procedures have been described, including a combination of soft-tissue releases, tendon transfers and osteotomies, all with the aim of achieving a plantigrade and balanced foot.Joint-sparing surgery is the best option in flexible cavovarus foot even in Charcot-Marie-Tooth (CMT) disease (peroneal muscular atrophy).Arthrodesis is indicated in severe rigid cavus foot or in degenerative cases. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160077. Originally published online at www.efortopenreviews.org.

Keywords: Charcot-Marie-Tooth disease; arthrodesis; cavus foot; osteotomy; tendon transfers.

Fig. 1

a and b) Rigid cavus foot with severe plantarflexed forefoot and claw toes.

Fig. 2

Severe hindfoot varus in patient affected by Charcot-Marie-Tooth disease.

Fig. 3

Radiographic angles on lateral standing radiograph. a) Talo-first metatarsal angle (Meary’s angle); b) Djian-Annonier angle less than 120° in cavus foot; c) calcaneal pitch; d) talo-calcaneal angle; e) first metatarsal-calcaneal angle (Hibb’s angle).

Fig. 4

Anteroposterior weight-bearing view demonstrating tilted talus and medial ankle degenerative joint secondary to a varus hindfoot deformity.

Fig. 5

Right ‘peek-a-boo’ heel is considered a sign of excessive heel varus (arrow).

Fig. 6

a and b) Silfverskiöld test to assess the presence of an isolated gastrocnemius tightness.

Fig. 7

Fluoroscopic control with pins before midfoot dorsal wedge osteotomy according to Cole’s procedure.

Fig. 8

Post-operative result after surgical correction of a left cavovarus deformity following midfoot osteotomy. Note the significant deformity of the left uncorrected side.

Fig. 9

Operative view showing a lateral bone wedge osteotomy described by Malerba and DiMarchi.

Fig. 10

Post-operative weight-bearing radiographs after surgical correction using triple arthrodesis associated with a first metatarsal osteotomy.