The Adult Clubfoot (Congenital Pes Cavus)

Clubfoot occurs in approximately 1 of every 1000 live births, with multiple theories proposed regarding the cause. The pathologic anatomy of the adult clubfoot consists of four components (cavus, adductus, varus, and equinus) and the specific soft tissue and bony procedures indicated for correction depend completely on the constellation of residual deformity that may exist. If the patient was successfully treated at a younger age and has only limited deformity, all that may be required is symptomatic treatment or bracing. Flexible deformities may be treated with a combination of soft tissue procedures and osteotomies or limited fusions, which will not compromise the essential joints of the ankle, subtalar, and talonavicular joints. More rigid deformities require fusions with their associated functional loss, in an attempt to obtain a plantigrade foot.