Cavovarus Foot: What You Need to Know

Cavovarus Foot Causes

• Deformity characterized by cavus (elevated longitudinal arch), plantarflexion of the 1st ray and forefoot pronation, hindfoot varus, and forefoot adduction
• Neurologic conditions account for 67% of cases
• Unilateral cases require ruling out tethered spinal cord or spinal cord tumor
• Charcot-Marie-Tooth disease is the most common cause of bilateral cases
• Muscle imbalances generate the deformity, with weak tibialis anterior and peroneus brevis overpowered by strong peroneus longus and posterior tibialis
• Talus fracture malunion, compartment syndrome, and crush injury can also cause cavovarus foot

Cavovarus Foot Symptoms

• Recurrent ankle sprains and lateral ankle pain
• Peroneal tendon pathology
• Lateral foot pain
• Excessive weight bearing by the lateral foot due to deformity, can result in 5th metatarsal stress fractures
• Painful plantar calluses under 1st metatarsal head and 5th metatarsal head or base, plantar fasciitis
• Elevated medial arch, forefoot pronation and tight gastronemius lead to contracture of the plantar fascia

Cavovarus Foot Treatment

• Nonoperative treatments include orthotics such as insoles and ankle/foot braces
• Operative treatments include soft tissue reconstruction, osteotomies, and ligament reconstruction
• Treatment depends on patient age and flexibility of the foot deformity

Operative Treatments

• Soft tissue reconstruction, plantar release, peroneus longus to brevis transfer, and posterior tibial tendon transfer
• Lengthening of gastrocnemius or tendoachilles (TAL)
• 1st metatarsal dorsiflexion osteotomy corrects flexible hindfoot varus deformities
• Lateralizing calcaneal valgus-producing osteotomy for rigid hindfoot varus deformities
• Ligament reconstruction such as Broström ligament reconstruction for chronic ankle instability due to ligamentous incompetence following long-standing cavovarus

Pediatric Cavovarus Foot

• May be congenital or hereditary when bilateral
• Diagnosis of neurologic condition is critical to render appropriate treatment
• Treatment is primarily nonoperative, with operative options reserved for severe and progressive cases

Adult Cavovarus Foot

• Most commonly due to Charcot-Marie-Tooth disease
• Treatment is both operative and nonoperative, depending on patient age and flexibility of the foot deformity
• Nonoperative treatments such as orthotics and braces are often used first, while surgery is reserved for progressive or severe cases

Cavovarus Foot Exercises

• Stretching exercises for tight muscles, including gastrocnemius and soleus stretching
• Strengthening exercises for weak muscles, including tibialis anterior and peroneus brevis strengthening
• Balance and proprioception exercises, including wobble board and single-leg balance exercises

Cavovarus Foot Shoes

• Accomodative shoe wear such as full-length semi-rigid insole orthotics with a depression for the first ray and a lateral wedge
• Supramalleolar orthosis (SMO)
• Ankle foot orthosis (AFO)
• Lace-up ankle brace and/or high-top shoe or boots

Cavovarus Foot Surgery

• Soft tissue reconstruction, osteotomies, and ligament reconstruction may be necessary
• Treatment ranges from orthotics to operative soft tissue release and operative osteotomies, depending on patient age and flexibility of the foot deformity
• Surgery is typically reserved for severe and progressive cases

Cavovarus Foot and Charcot-Marie-Tooth Disease

• CMT is the most common cause of bilateral cases
• Nerve damage causes muscle weakness and atrophy, leading to cavovarus foot deformity
• In addition to foot deformity, CMT can cause hand weakness and atrophy, scoliosis, and spinal dysraphism

Cavovarus Foot and Cerebral Palsy

• Cavovarus foot is a common finding in patients with cerebral palsy
• Treatment is supportive and may involve nonoperative treatments or surgery

Cavovarus Foot and Spinal Cord Injury

• Tethered spinal cord and spinal cord tumors can cause unilateral cavovarus foot
• Treatment is surgical and aims to correct the underlying disorder

Cavovarus Foot and Stroke

• In some cases, stroke can cause cavovarus foot due to muscle weakness and atrophy
• Treatment is supportive and may involve nonoperative treatments or surgery

Summary

Cavovarus Foot is a common condition that may be caused by a neurologic or traumatic disorder, seen in both the pediatric and adult population, that presents with a cavus arch and hindfoot varus. Diagnosis is made clinically with the presence of a foot deformity characterized by cavus, hindfoot varus, plantarflexion of the 1st ray, and forefoot adduction. A coleman block test is useful to assess for the flexibility of the hindfoot deformity to assist with surgical planning. Treatment ranges from orthotics to operative soft tissue release and operative osteotomies depending on patient age and flexibility of the foot deformity.