Cavus Foot Surgery

A cavus foot has a high arch. The cavus can range from being slightly high to severely deformed, causing a patient to walk on the outside of the foot. Surgery sometimes is needed to realign the foot.

Treatment ranges from changes in shoes to surgeries, depending on the amount of deformity and related problems. The main goals of cavus foot surgery is to reduce pain, improve function, and prevent further damage or injuries.

Conditions

While the cause of a high-arched foot is often unknown, a cavus could be caused by nerve disease, clubfoot, or injury.

Your foot and ankle orthopaedic surgeon may recommend surgery if there is no relief with physical therapy, orthotics, changes in shoes, and/or changes in activity. Some patients also will experience tendon problems, ankle weakness, and foot fractures. These patients may require other procedures to address related problems.

If you have medical problems that make surgery unsafe such as any infections or blood vessel disease, cavus foot surgery may not be appropriate.

Surgery

The surgical procedures involved with the correction of the cavus foot are varied and depend on the patient’s foot and ankle alignment and related problems. Typically, the foot is realigned by cutting and repositioning the bones (known as osteotomies). Repairing fractures, tightening ligaments, and transferring tendons also may be necessary. The goal is to provide a foot that evenly distributes weight along both inside and outside edges. A variety of incisions may be needed to perform the procedures related to the correction of the cavus foot.

• Soft-tissue surgery:

Cavus foot is caused in part by an over-pull of one of the lateral ankle muscles. A release of this tendon can be performed on the outside of the ankle. Additionally, a transfer of this tendon can be performed to help correct the deformity of the ankle joint. Often patients will have a tightness of their gastrocnemius muscle, one of the main muscles in the calf. This can increase the deformity or prevent a correction from working. It is addressed with a lengthening of a part of the calf muscle or Achilles tendon. This is often performed through one or more small cuts in the back of the leg/ankle. Finally, the plantar fascia may be tight. The plantar fascia is a cord-like structure that runs from the heel to the front part of the foot. Partial or complete plantar fascia release may be done.

• Dorsiflexion osteotomy of the first metatarsal:

This procedure flattens out the arch.

• Calcaneal (heel bone) osteotomy:

This procedure is performed to bring the heel bone back under the leg. This is needed if correction of the deformity in the front of the foot does not also correct the back of the foot or ankle. A calcaneal osteotomy can be performed several ways and often is held in place with one or more screws.

• Tendon transfers:

Too much pull of certain muscles and tendons often is the cause of the deformity related with a cavus foot. Moving one of these muscles or tendons may help the foot work better. In addition, patients with a cavus foot may have weakness in moving the foot up, which is sometimes called a foot drop. In these cases, a tendon from the back of the ankle may be moved to the top of the foot to help improve strength.

• Bony surgery:

Correcting the deformity of the foot may not be possible with soft tissue procedures alone. In these instances, one or more bone cuts (osteotomies) may be needed. Instead of a bone cut, a fusion (arthrodesis) procedure may be used. A fusion removes the joint between two bones so they grow together over time. During a fusion the bones may be held in place with plates or screws.

• Fusion:

Sometimes patients have a deformity that has caused damage to the joints. In these cases, soft tissue procedures or bone cuts may not be enough, and it may be necessary to eliminate the motion of the joint.

• Toe surgery:

Clawed toes are a common problem in patients with cavus foot deformity. This can be treated with tendon surgery, fusion or removal of part of the toe bones. Following surgery the toes may temporarily be held in place with pins.

Rehabilitation

Recovery typically requires at least six weeks of non-weight bearing so the bones and other structures can heal. In many cases, an even longer period of protection or non-weight bearing is needed. Typically, the final results are not seen for approximately 6-12 months after surgery.

All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Particular complications associated with cavus foot surgery include incomplete correction of deformity, return of deformity and incomplete healing of the bone.