Skip to main content
SpringerLink
Log in
Book cover

Complications in Foot and Ankle Surgery pp 303–327Cite as

Pes Cavovarus Surgery

  • Chapter
  • First Online:

  • 1715 Accesses

Abstract

Surgical correction of the cavovarus foot deformity can be extremely challenging. Not only are you dealing with a very complex foot structure but also understanding the neurological etiology is critical to a successful outcome. Cavovarus deformity can be caused from either static contracture or dynamic contracture. When treating patients with dynamic contractures, where there is a progressive nature to the deformity, long-term outcomes are especially difficult to predict [1]. Static contractures, on the other hand, are easier to predict, and treatment is more straightforward. This chapter is intended to identify the crucial elements of procedure selection, discuss technical pearls for the commonly performed reconstructive procedures to prevent complications, and review specific complications and ways to manage them effectively.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Kroon M, Faber FW, van der Linden M. Joint preservation surgery for correction of flexible pes cavovarus in adults. Foot Ankle Int. 2010;31:24–9.

    Article  PubMed  Google Scholar 

  2. Aminian A, Sangeorzan BJ. The anatomy of cavus foot deformity. Foot Ankle Clin. 2008;13(2):191–8.

    Article  PubMed  Google Scholar 

  3. Statler TK, Tullis BL. Pes cavus. J Am Podiatr Med Assoc. 2005;95(1):42–52.

    Article  PubMed  Google Scholar 

  4. Smith T, Green D. Pes Cavus. In: Banks AS, Downey MS, Martin DE, et al., editors. McGlamry’s comprehensive textbook of foot and ankle surgery, vol. 1. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 761–98.

    Google Scholar 

  5. Smith T, Sapp M, Jobanpldtra R. Pes Cavus: an update of classification and management. PI Update Chapter. 2006;2:7–16.

    Google Scholar 

  6. Krause FG, Guyton GP. Pes Cavus. In: Mann RA, Coughlin MJ, editors. Surgery of the foot and ankle. 9th ed. St Louis (MO): Mosby; 2011. p. 1361–82.

    Google Scholar 

  7. McCluskey WP, Lovell WW, Cummings RJ. The cavovarus foot deformity. Etiology and management. Clin Orthop Relat Res. 1989;248:27–37.

    Google Scholar 

  8. Silver RL, de la Garza J, Rang M. The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg (Br). 1985;67(3):432–7.

    CAS  Google Scholar 

  9. Deben SE, Pomeroy GC. Subtle cavus foot: diagnosis and management. J Am Acad Orthop Surg. 2014;22(8):512–20.

    Article  PubMed  Google Scholar 

  10. Maskill MP, Maskill JD, Pomeroy GC. Surgical management and treatment algorithm for the subtle cavovarus foot. Foot Ankle Int. 2010;31(12):1057–63.

    Article  PubMed  Google Scholar 

  11. Watanabe RS. Metatarsal osteotomy for the cavus foot. Clin Orthop Relat Res. 1990;252:217–30.

    Google Scholar 

  12. Leeuwesteijn AE, de Visser E, Louwerens JW. Flexible cavovarus feet in Charcot-Marie-Tooth disease treated with first ray proximal dorsiflexion osteotomy combined with soft tissue surgery: a short-term to mid-term outcome study. Foot Ankle Surg. 2010;16(3):142–7.

    Article  CAS  PubMed  Google Scholar 

  13. DeVries JG, McAlister JE. Corrective osteotomies used in cavus reconstruction. Clin Podiatr Med Surg. 2015;32(3):375–87.

    Article  PubMed  Google Scholar 

  14. Sammarco GJ, Taylor R. Cavovarus foot treated with combined calcaneus and metatarsal osteotomies. Foot Ankle Int. 2001;22(1):19–30.

    Article  CAS  PubMed  Google Scholar 

  15. Conti SF, Kirchner JS, VanSickle D. Midfoot osteotomies. Foot Ankle Clin. 2001;6(3):519–32.

    Article  CAS  PubMed  Google Scholar 

  16. Sammarco GJ, Taylor R. Combined calcaneal and metatarsal osteotomies for the treatment of cavus foot. Foot Ankle Clin. 2001;6(3):533–43.

    Article  CAS  PubMed  Google Scholar 

  17. Zanolli DH, Glisson RR, Utturkar GM, Eckel TT, JK DO. Calcaneal “Z” osteotomy effect on hindfoot varus after triple arthrodesis in a cadaver model. Foot Ankle Int. 2014;35(12):1350–7.

    Article  PubMed  Google Scholar 

  18. Mandracchia VJ, Mandi DM, Nickles WA, Barp EA, Sanders SM. Pantalar arthrodesis. Clin Podiatr Med Surg. 2004;21(3):461–70.

    Article  PubMed  Google Scholar 

  19. Provelengios S, Papavasiliou KA, Kyrkos MJ, Kirkos JM, Kapetanos GA. The role of pantalar arthrodesis in the treatment of paralytic foot deformities. A long-term follow-up study. J Bone Joint Surg Am. 2009;91(3):575–83.

    Article  PubMed  Google Scholar 

  20. Provelengios S, Papavasiliou KA, Kyrkos MJ, Sayegh FE, Kirkos JM, Kapetanos GA. The role of pantalar arthrodesis in the treatment of paralytic foot deformities. Surgical technique. J Bone Joint Surg Am. 2010;92(Suppl 1 Pt 1):44–54.

    Article  PubMed  Google Scholar 

  21. Wapner KL. Triple arthrodesis in adults. J Am Acad Orthop Surg. 1998;6(3):188–96.

    Article  CAS  PubMed  Google Scholar 

  22. Steindler A. Operative treatment of pes cavus. Surg Gynecol Obstet. 1917;24:612–5.

    Google Scholar 

  23. Steindler A. Stripping of the os calcis. Am J Orthop Surg. 1920;2:8–12.

    Google Scholar 

  24. Wapner K. Pes Cavus. In: Myerson MS, editor. Foot and ankle disorders. Philadelphia: WB Saunders; 2000. p. 919–41.

    Google Scholar 

  25. Mann R. Pes Cavus. In: Mann RA, Coughlin MJ, editors. Surgery of the foot and ankle. St Louis (MO): Mosby; 1993. p. 785–801.

    Google Scholar 

  26. Schuberth JM, Babu-Spencer N. The impact of the first ray in the cavovarus foot. Clin Podiatr Med Surg. 2009;26(3):385–93.

    Article  PubMed  Google Scholar 

  27. Azmaipairashvili Z, Riddle EC, Scavina M, Kumar SJ. Correction of cavovarus foot deformity in Charcot-Marie-Tooth disease. J Pediatr Orthop. 2005;25(3):360–5.

    Article  PubMed  Google Scholar 

  28. Berg EE. Percutaneous Achilles tendon lengthening complicated by inadvertent tenotomy. J Pediatr Orthop. 1992;12(3):341–3.

    Article  CAS  PubMed  Google Scholar 

  29. Kay RM, Rethlefsen SA, Ryan JA, Wren TA. Outcome of gastrocnemius recession and tendo-achilles lengthening in ambulatory children with cerebral palsy. J Pediatr Orthop B. 2004;13(2):92–8.

    PubMed  Google Scholar 

  30. Thompson GH, Hoyen HA, Barthel T. Tibialis anterior tendon transfer after clubfoot surgery. Clin Orthop Relat Res. 2009;467(5):1306–13.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Gray K, Burns J, Little D, Bellemore M, Gibbons P. Is tibialis anterior tendon transfer effective for recurrent clubfoot? Clin Orthop Relat Res. 2014;472(2):750–8.

    Article  PubMed  Google Scholar 

  32. Shapiro F, Bresnan MJ. Orthopaedic management of childhood neuromuscular disease. Part II: peripheral neuropathies, Friedreich’s ataxia and arthrogryposis multiplex congenital. J Bone Joint Surg. 1982;64A:949–53.

    Article  Google Scholar 

  33. Lampasi M, Bettuzzi C, Palmonari M, et al. Transfer of the tendon of tibialis anterior in relapsed congenital clubfoot: long-term results in 38 feet. J Bone Joint Surg (Br). 2010;92:277–83.

    Article  CAS  Google Scholar 

  34. Bluman E, Dowd T. The basics and science of tendon transfers. Foot Ankle Clin. 2011;16:385–99.

    Article  PubMed  Google Scholar 

  35. Ezra E, Hayek S, Gilai AN, et al. Tibialis anterior tendon transfer for residual dynamic supination deformity in treated club feet. J Pediatr Orthop B. 2000;9:207–11.

    Article  CAS  PubMed  Google Scholar 

  36. Reilly CM. Principles of muscle-tendon surgery and tendon transfers. In: Banks AS, Downey MS, Martin DE, et al., editors. McGlamry’s comprehensive textbook of foot and ankle surgery. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 1523–66.

    Google Scholar 

  37. Younger AS, Hansen Jr ST. Adult cavovarus foot. J Am Acad Orthop Surg. 2005;13(5):302–15.

    Article  PubMed  Google Scholar 

  38. Ward CM, Dolan LA, Bennett DL, et al. Long-term results of reconstruction for treatment of a flexible cavovarus foot in Charcot-Marie- Tooth disease. J Bone Joint Surg Am. 2008;90:2631–42.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Jay, Richard. Anatomic, mechanical, and surgical considerations in myeloblastic maneuvers about the foot and ankle. Current therapy in podiatric surgery. 1989.

    Google Scholar 

  40. Myerson MS. Paralytic disorders of the lower extremity. In: Myerson MS, editor. Foot and ankle disorders. Philadelphia: WB Saunders; 2000. p. 883–99.

    Google Scholar 

  41. Mann RA. Tendon transfers and electromyography. Clin Orthop Relat Res. 1972;85:64–6.

    Article  CAS  PubMed  Google Scholar 

  42. Hsu J, Hoffer M. Posterior tibial tendon transfer anteriorly through the interosseous membrane: a modification of the technique. Clin Orthop Relat Res. 1978;131:202–4.

    Google Scholar 

  43. Miller GM, Hsu JD, Hoffer MM, Rentfro R. Posterior tibial tendon transfer: a review of the literature and analysis of 74 procedures. J Pediatr Orthop. 1982;2(4):363–70.

    Article  CAS  PubMed  Google Scholar 

  44. DiDomenico LD, Cane LD. Key insights on tendon transfers for drop foot. Podiatry Today. 2009;22(5)

    Google Scholar 

  45. Williams PF. Restoration of muscle balance of the foot by transfer of the tibialis posterior. J Bone Joint Surg (Br). 1976;56:217–9.

    Google Scholar 

  46. Goecker RM, Banks AS, Downey MS, et al. Charcot-Marie-tooth disease. In: Bobery JT, Downey MS, Nakra A, et al., editors. McGlamry’s comprehensive textbook of foot and ankle surgery, vol. 2. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 761–98.

    Google Scholar 

  47. Beals TC, Nickisch F. Charcot-Marie-tooth disease and the cavovarus foot. Foot Ankle Clin. 2008;13(2):259–74.

    Article  PubMed  Google Scholar 

  48. Gould N. Surgery in advanced Charcot-Marie-tooth disease. Foot Ankle Clin. 1984;4(5):267–73.

    Article  CAS  Google Scholar 

  49. Molloy R, Tisdel C. Failed treatment of peroneal tendon injuries. Foot Ankle Clin. 2003;8(1):115–29.

    Article  PubMed  Google Scholar 

  50. Squires N, Myerson MS, Gamba C. Surgical treatment of peroneal tendon tears. Foot Ankle Clin. 2007;12(4):675–95.

    Article  PubMed  Google Scholar 

  51. Mook WR, Parekh SG, Nunley JA. Allograft reconstruction of peroneal tendons: operative technique and clinical outcomes. Foot Ankle Int. 2013;34(9):1212–20.

    Article  PubMed  Google Scholar 

  52. Olson SL, Ledoux WR, Ching RP, et al. Muscular imbalances resulting in a clawed hallux. Foot Ankle Int. 2003;24:477–85.

    Article  PubMed  Google Scholar 

  53. Breusch SJ, Wenz W, Döderlein L. Function after correction of a clawed great toe by a modified Robert Jones transfer. J Bone Joint Surg (Br). 2000;82(2):250–4.

    Article  CAS  Google Scholar 

  54. Abousayed M, Kwon JY. Hallux claw toe. Foot Ankle Clin. 2014;19:59–63.

    Article  PubMed  Google Scholar 

  55. Shaffer LW. Osteotomy of the metatarsals for pes cavus. South Med J. 1977;70:77–9.

    Article  PubMed  Google Scholar 

  56. Cole WH. The classic. The treatment of claw-foot. By Wallace H. Cole. 1940. Clin Orthop Relat Res. 1983;181:3–6.

    Google Scholar 

  57. Tullis BL, Mendicino RW, Catanzariti AR, et al. The Cole midfoot osteotomy: a retrospective review of 11 procedures in 8 patients. J Foot Ankle Surg. 2004;43:160–5.

    Article  PubMed  Google Scholar 

  58. Groner TW, DiDomenico LA. Midfoot osteotomies for the cavus foot. Clin Podiatr Med Surg. 2005;22:247–6.

    Article  PubMed  Google Scholar 

  59. Wülker N, Hurschler C. Cavus foot correction in adults by dorsal closing wedge osteotomy. Foot Ankle Int. 2002;23:344–34.

    Article  PubMed  Google Scholar 

  60. Dwyer FC. Osteotomy of the calcaneum for pes cavus. J Bone Joint Surg (Br). 1959;41-B(1):80–6.

    CAS  Google Scholar 

  61. Robinson DS, Clark Jr B, Prigoff MM. Dwyer Calcaneal osteotomy for treatment of calcaneal varus. J Foot Surg. 1988;27:541–4.

    CAS  PubMed  Google Scholar 

  62. Bariteau JT, Blankenhorn BD, Tofte JN, DiGiovanni CW. What is the role and limit of calcaneal osteotomy in the cavovarus foot? Foot Ankle Clin. 2013;18(4):697–714.

    Article  PubMed  Google Scholar 

  63. Dekel S, Weissman SL. Osteotomy of the calcaneus and concomitant plantar stripping in children with talipes cavo-varus. J Bone Joint Surg (Br). 1973;55(4):802–8.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Past President, American College of Foot and Ankle Surgeons, Department of Orthopedics INOVA Fairfax Medical Campus, 3300 Gallows Road, Falls Church, VA, 22042, USA

    Richard Derner

Authors
  1. Richard Derner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard Derner .

Editor information

Editors and Affiliations

  1. Capital Orthopedics and Sports Medicine, Clive, Iowa, USA

    Michael S. Lee

  2. Akron General Orthopedics, Inc., Akron, Ohio, USA

    Jordan P. Grossman

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Derner, R. (2017). Pes Cavovarus Surgery. In: Lee, M., Grossman, J. (eds) Complications in Foot and Ankle Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-53686-6_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-53686-6_23

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-53684-2

  • Online ISBN: 978-3-319-53686-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation