Cavus foot correction typically involves a combination of: dorsiflexion osteotomy of the first metatarsal (to correct forefoot pronation/plantarflexion), calcaneal osteotomy (Dwyer closing wedge to correct hindfoot varus), plantar fascia release, peroneus longus to brevis tendon transfer, posterior tibial tendon transfer to the dorsum of the foot (for foot drop), and occasionally midfoot or hindfoot fusion for rigid deformity. The specific combination is determined by the Coleman block test and clinical assessment. The operation takes two to four hours.
Surgery is recommended for symptomatic cavus foot causing lateral ankle instability, recurrent sprains, metatarsalgia, callosity formation under the metatarsal heads, difficulty with footwear, and progressive deformity. Common underlying causes include Charcot-Marie-Tooth disease, post-stroke, spinal cord lesions, and idiopathic cavus.
Lateral wedge insoles, custom orthotics with metatarsal domes, ankle bracing, appropriate footwear with a wide toe box, and physiotherapy for peroneal and ankle stability training.
Standing X-rays including Coleman block view. Neurological assessment and nerve conduction studies to identify the underlying cause. MRI of the spine if neurological cause is suspected. Comprehensive deformity analysis.
Plantigrade, balanced foot. Improved stability. Reduced callosity and pain. Most patients achieve significant functional improvement.
Prolonged recoveryExpected
Multiple procedures require six to twelve weeks non-weight-bearing.
Multiple scarsExpected
From several incisions.
StiffnessCommon
Some loss of foot flexibility.
SwellingExpected
Prolonged foot swelling.
Non-unionUncommon
Osteotomy or fusion sites may fail to heal.
Over-correctionRare
Converting a cavus foot to a planus (flat) foot.
Nerve injuryUncommon
Peroneal or tibial nerve branches.
Wound healingUncommon
Multiple incisions increase risk.
RecurrenceCommon
Particularly in progressive neurological conditions like CMT.
Transfer tendon failureUncommon
The transferred tendon may not function adequately.
General or spinal anaesthesia with ankle block.
Non-weight-bearing for six to eight weeks. Boot for four to six weeks. Custom orthotics long-term. Physiotherapy for ankle stability and gait retraining. Full recovery six to twelve months.
X-rays at six weeks and three months. Long-term monitoring, particularly for progressive neurological conditions.
What causes cavus foot?
Two-thirds of cavus feet have an underlying neurological cause — most commonly Charcot-Marie-Tooth disease (hereditary motor and sensory neuropathy). Other causes include stroke, spinal cord lesions, cerebral palsy, and polio. One-third are idiopathic (no identifiable cause). Any new or progressive cavus foot should prompt neurological investigation.
What is the Coleman block test?
A clinical test where the patient stands with the first metatarsal off the edge of a block. If the heel varus corrects (the heel moves into neutral), the cavus is driven by forefoot pronation and is correctable with a first metatarsal osteotomy. If it doesn't correct, the hindfoot is rigid and requires calcaneal osteotomy or fusion.