Assessment and management of cavus foot deformity

The cavus foot, or pes cavus, is a deformity of the foot characterised by a high longitudinal arch. It is classically associated with neurological conditions and muscle imbalance. The deformity varies in severity and can affect any or all of the hindfoot, midfoot or forefoot. Careful examination should be performed and underlying neurological conditions sought. We outline an á la carte approach to surgical management, in which deformity of the ankle and hindfoot is addressed before moving on to assessment and correction of the mid- and forefoot. Flexible deformities can be corrected with ligament rebalancing and osteotomies whereas fixed deformity frequently requires arthrodesis. Dynamic muscle equilibrium should always be re-established using appropriate tendon transfers.