Foot
Cavovarus Foot
About Your Condition
A cavovarus foot is a deformity in which the arch sits abnormally high (cavus) and the heel tilts inward (varus). It is often accompanied by clawing of the toes and a foot that appears rigid and high-arched rather than flat. The deformity shifts weight-bearing towards the outer border of the foot and the heads of the outer metatarsals, which can lead to pain, callosities, and instability.
In many patients, cavovarus foot is linked to an underlying neurological condition — most commonly Charcot-Marie-Tooth disease, a hereditary peripheral neuropathy that causes gradual imbalance between the muscles that move the foot. Other causes include previous nerve injury, spinal conditions, cerebral palsy, and clubfoot treated in childhood. Because an underlying neurological cause is common, Dr Hogan may recommend further assessment, including nerve conduction studies or a neurology opinion, to help guide treatment and long-term planning.
The high arch and heel varus also make the ankle mechanically less stable, so many patients with cavovarus feet experience recurrent ankle sprains or a sense of the ankle giving way, particularly on uneven ground.
Non-Operative Management
Non-operative management focuses on accommodating the deformity and improving dynamic stability, though it cannot correct the underlying shape of the foot.
Orthotics and Footwear
- A custom orthotic with a lateral wedge and first-ray cut-out can help redistribute pressure away from the outer border of the foot and the base of the first metatarsal.
- Supportive shoes with a wide, stable base and cushioned sole help accommodate the deformity and reduce callosity formation. A neutral shoe is preferred over a motion-control shoe, which is built to correct the opposite problem (overpronation) and can worsen symptoms in a supinated, high-arched foot.
Bracing
- An ankle-foot orthosis (AFO) or lace-up ankle brace can provide additional lateral stability for patients with recurrent ankle sprains or a sense of instability.
Physiotherapy
- Peroneal strengthening and balance/proprioception exercises can improve dynamic stability of the ankle and reduce the frequency of sprains in appropriately selected patients.
- Stretching of the plantar fascia and calf can help with forefoot symptoms, though it will not reverse an established deformity.
When to Consider Surgery
Surgery is considered when symptoms significantly limit your daily activities despite an adequate trial of orthotics, bracing, and physiotherapy, or when the deformity is progressive. Earlier intervention is preferable while the deformity remains flexible and can still be passively corrected — once it becomes fixed and rigid, correction requires a more extensive procedure involving joint fusion rather than the soft tissue and osteotomy techniques used for a flexible deformity, so delaying surgery can mean a bigger operation is ultimately needed.
If the skin or soft tissue overlying a pressure area is at risk of breaking down — for example, a callosity that is ulcerating or showing signs of impending breakdown — this is no longer simply a quality of life issue and needs to be assessed more urgently, as skin breakdown in this setting can lead to infection.
Correction of a cavovarus foot is a tailored procedure, built around the specific components of the deformity present in each patient's foot.