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Adult Cavovarus Foot

Dr. Younger is Director, Foot and Ankle Program, Providence Health Care, and Clinical Associate Professor, The Division of Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada. Dr. Hansen is Chief, Foot and Ankle Service, and Professor and Chairman Emeritus, Department of Orthopaedics, University of Washington, Harborview Medical Center, Seattle, WA.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Younger and Dr. Hansen.

Reprint requests: Dr. Younger, University of British Columbia, 401-1160 Burrard Street, Vancouver, BC V6Z 2E8 Canada.

Cavovarus foot deformity, which often results from an imbalance of muscle forces, is commonly caused by hereditary motor sensory neuropathies. Other causes are cerebral palsy, cerebral injury (stroke), anterior horn cell disease (spinal root injury), talar neck injury, and residual clubfoot. In cavovarus foot deformity, the relatively strong peroneus longus and tibialis posterior muscles cause a hindfoot varus and forefoot valgus (pronated) position. Hindfoot varus causes overload of the lateral border of the foot, resulting in ankle instability, peroneal tendinitis, and stress fracture. Degenerative arthritic changes can develop in overloaded joints. Gait examination allows appropriate planning of tendon transfers to correct stance and swing-phase deficits. Inspection of the forefoot and hindfoot positions determines the need for soft-tissue release and osteotomy. The Coleman block test is invaluable for assessing the cause of hindfoot varus. Prolonged use of orthoses or supportive footwear can result in muscle imbalance, causing increasing deformity and irreversible damage to tendons and joints. Rebalancing tendons is an early priority to prevent unsalvageable deterioration of the foot. Muscle imbalance can be corrected by tendon transfer, corrective osteotomy, and fusion. Fixed bony deformity can be addressed by fusion and osteotomy.

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				T. Philbin Rigid Equinovarus Deformity Corrected With a Multiplanar External Fixator Foot & Ankle Specialist, August 1, 2008; 1(4): 247 - 249. [PDF]

				F. Krause, M. Windolf, K. Schwieger, and M. Weber Ankle joint pressure in pes cavovarus J Bone Joint Surg Br, December 1, 2007; 89-B(12): 1660 - 1665. [Abstract] [Full Text] [PDF]