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 for the repaired foot to evenly distribute 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 calf muscle. 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 on the bottom of your foot that runs from the heel to the front part of the foot. Your surgeon may perform a partial or complete plantar fascia release.
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 correcting 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 associated 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 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, your surgeon may perform a
fusion (arthrodesis) procedure. 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.
Joint 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.
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 12 months after surgery.
Risks and Complications
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.
If I have cavus foot surgery, will my foot be totally normal?
Foot surgery is difficult, especially when large amounts of correction are needed. The ability to bring the foot into a new position may not be lasting, even if everything
looks perfect in the operating room. The goal is to provide improved position and function of the foot and ankle. In some patients with very severe deformity, the goal is a foot that functions well in a brace.
How long will it take to recover?
Surgery for a cavus foot deformity is a complex procedure. It is reasonable to expect your recovery to take approximately 12 months. This can affect your ability to work and do daily tasks for several months after surgery. Persistent issues such as swelling and stiffness of the foot can take months to resolve but generally improve with time.
Original article by Thomas Douglas, MD
Contributors/Reviewers: W. Bret Smith, DO; Zachary Vaupel, MD; Patrick Maloney, MD; Sudheer Reddy, MD
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