What is a cavus foot?
A cavus or high-arched foot may have many foot shapes. This may range from an arch
that is slightly high to a severe deformity that causes a patient to walk on the outside of the foot. Surgery is occasionally required to realign the foot.
There are different causes of a high-arched foot. In many cases, the cause is unknown. In other cases, the cause is a nerve disease, clubfoot or injury. Treatment ranges from changes in shoewear to surgeries, depending on the amount of deformity and related problems.
What are the goals of cavus foot surgery?
The main goal of surgery is to reduce pain and improve function. It may also reduce other injuries such as repeated ankle sprains and broken bones.
What signs indicate surgery may be needed?
Surgery may be considered if there is no relief with physical therapy, changes in shoewear and/or changes in activity. Some patients will also have tendon problems, ankle weakness and foot fractures. These patients may require other procedures to address related problems.
When should I avoid surgery?
If you have medical problems that make surgery unsafe, any infections or blood vessel disease, cavus foot surgery may not be appropriate.
General Details of Procedure
The surgical procedures involved with the correction of the cavus foot are varied. Theses may include correction of the bony deformity, ankle looseness and the muscle imbalances that cause the deformity. The goal is to provide a foot that evenly distributes weight along both inside and outside edges. A variety of incisions may be needed to perform the procedures related to the correction of the cavus foot.
Cavus foot is caused in part by an over-pull of one of the lateral
ankle muscles. A release of this tendon can be performed on the outside of the ankle. Additionally, a transfer of this tendon can be performed to help in correcting deformity of the ankle joint.
Often patients will have a tightness of their gastrocnemius muscle, one of the main muscles in the calf. This can increase the deformity or prevent a correction from working. It is addressed with a lengthening of a part of the calf muscle or Achilles tendon. This is often performed through one or more small cuts in the back of the leg/ankle.
Finally, the plantar fascia may be tight. The plantar fascia is a cord-like structure that runs from the heel to the front part of the foot. Partial or complete plantar fascia release may be done.
Tendon transfers: Too much pull of certain muscles and tendons is often the cause of the deformity related with a cavus foot. Moving one of these muscles or tendons may help the foot work better. In addition, patients with a cavus foot may have weakness in moving the foot up, which is sometimes called a foot drop. In these cases, a tendon from the back of the ankle may be moved to the top of the foot to help improve strength.
Bony surgery: Correcting the deformity of the foot may not be possible with soft tissue procedures alone. In these instances, one or more bone cuts (osteotomies) may be needed. Instead of a bone cut, a fusion (arthrodesis) procedure may be used. A fusion removes the joint between two bones so they grow together over time. During a fusion the bones may be held in place with plates or screws.
Dorsiflexion osteotomy of the first metatarsal: This procedure flattens out the arch.
Calcaneal osteotomy: This procedure is performed to bring the heel bone back under the leg. This is needed if correction of the deformity in the front of the foot does not also correct the back of the foot or ankle. A calcaneal osteotomy can be performed several ways and is often held in place with one or more screws.
Fusion: Sometimes patients have a deformity that has caused damage to the joints. In these cases, soft tissue procedures or bone cuts may not be enough, and it may be necessary to eliminate the joint.
Toe surgery: Clawed toes are a common problem with cavus foot deformity. This can be treated with tendon surgery, fusion or removal of part of the toe bones. Following surgery the toes are often temporarily held in place with pins.
What happens after surgery?
Recovery typically requires at least six weeks of non-weight bearing so the bones and other structures can heal. In many cases, an even longer period of protection and/or non-weight bearing is needed. Typically, the final results are not seen for approximately six to 12 months after surgery.
There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Particular complications associated with cavus foot surgery include incomplete correction of deformity, return of deformity and incomplete fusion.
Frequently Asked Questions
If I have surgery will my foot be totally normal?
Foot surgery is difficult, especially when large amounts of deformity correction are needed. The ability to bring the foot into a new position may not be lasting, even if everything looks perfect in the operating room. The goal is to provide improved position and function of the foot and ankle. In some patients with very severe deformity, the goal is a foot that functions well in a brace.
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