Pes cavus

Principal authors: Louise Crawford, Jim Barrie

Latest evidence check March 2010

Several midfoot osteotomies have been described including techniques to remove parts of the talus – a dorsal wedge from the talar neck (Steindler 1921), anterior tarsal resection (Cole 1940); fusion of the first metatarsocuneiform/navicular osteotomy (McElvenny and Caldwell, 1958). Swanson et al reported good outcomes for proximal metatarsal osteotomies plus plantar fascia release plus tendon transfer, but study groups were very small. Jahss (1980) described a truncated wedge osteotomy of the tarsometatarsal joints to correct depression of the metatarsal joints without violating the subtalar joint. These tarsometatarsal osteotomies are designed to correct the forefoot equinus but lie distal to the apex of the cavus deformity. Potential problems with this procedure include overcorrection with forefoot rockerbottom and abduction.

The tarsal V-osteotomy (Japas) allows for correction of anterior pes cavus while the hind part of the foot maintains its normal relationship to the axis of the leg. The osteotomy lies at the apex of the cavus deformity and allows for good correction of dorsoplantar deformity. Their follow up was only for 2-6 years. Its limitations are that it only corrects small add or abduction deformities of the forefoot and causes some widening of the foot in the midtarsal region. It is also not advocated as treatment for long-standing cavus. He reported satisfactory results in 12 of 17 patients (70%).

The Akron dome osteotomy advocated by Wilcox was also an osteotomy centred at the apex of the deformity.  They reported correction of greater rotational and extensive angular deformities.  At initial review they reported satisfactory results in 94% of their patients over the age of 8 – this totalled 10 patients. Longer follow-up at 2-29yr (Weiner 2008) found painfree, plantigrade feet in 106/139 feet and results tended to be better in patients who had the procedure at 8 years or older.

Giannini et al (2002) described a combination of plantar fasciotomy, naviculocuneiform arthrodesis and cuboid osteotomy. There were 69 feet included and they reported correction of the heel varus from 6 to 2 degrees. Excellent results were reported in 23 (33%), good for 27 (39%), fair for 17 (25%) and poor for 2 (3%).  They did not however, specify a length of time of follow up, nor what constituted a good result.