11 - Cavus Foot Correction

Abstract

Correction of the cavus foot can be difficult with regards to both the decision making and execution of the surgery. With adherence to some basic principles, however, the deformity can be well corrected and the foot dynamically balanced, with maintenance of as much motion as possible. One must not rigidly adhere to the Coleman block test to determine flexibility and the need for certain procedures, in particular osteotomy vs arthrodesis. The most important component of the evaluation is to identify additional deforming forces on the foot. Invariably, the peroneus longus muscle is stronger than the anterior tibial muscle, and the posterior tibial muscle is stronger than the peroneus brevis muscle, with a variable degree of contracture of the gastrocnemius and soleus muscles present. In the literature from the 1980s the triple arthrodesis was not associated with a good and predictable outcome for the cavus foot. We disagree with this finding, since a triple arthrodesis is a good procedure, provided that the foot is correctly balanced with additional osteotomy and tendon transfers as needed. If a triple arthrodesis is thought to be the procedure of choice, it should be performed with appropriate transfer of the posterior tibial tendon, as well as additional tendon transfers as required. One must be aware of the apex of the deformity since this will determine the type of procedure, in particular when an arthrodesis is selected.