May cause complaints of lateral ankle instability. (Manoli A, Foot Ankle Int 2005;26:256).
Determine if deformity is flexible or rigid; static or progressive.
Evaluate for neuromotor disease.
Coleman Block test:
Cavovarus Foot Xray / Diagnositc Tests
A/P, Lateral, and Mortise Ankle and A/P, Oblique, Lateralfoot xrays indicated. Llateral radiograph shows forefoot equinus and parallelism between the calcaneus and talus.
joints generally free of degenerative arthritis.
Cavovarus Foot Classification / Treatment
Mild/familial/idiopathic: physical therapy, shoe modification. Cushioned running shoes with equal medial and lateral stiffness without extra arch support. Consider orthotic with recessed 1st metatarsal. Avoid anti-pronation shoes which exacerbate the deformity. Consider dorsiflexion osteotomy of the 1st metatarsal.
Forefoot driven: hindfoot deformity is flexible; varus position is related to valgus positioning of the forefoot and corrects with Coleman block test.
Hindfoot Driven: hindfoot deformity is fixed and does not correct with Coleman block test. RX: calcaneal osteotomy or subtalar fusion to correct varus defomity and dorsiflexion osteotomy ofthe first ray.
Lateral closing wedge calcaneal osteotomy to correct the hindfoot varus, dorsiflexing osteotomy of the first metatarsal, and transfer of the peroneus longus tendon to the peroneus brevis to correct forefoot equinus. Steindler striping is often necessary to correct the cavus deformity. (Sammarco GJ, Foot Ankle Clin 2001;6:533).
Arthrodesis should be reserved for joints that have degenerative changes or deformities that cannot be corrected by other means.