Arthrodesis for the Cavus Foot When, Where, and How?

When the cavus foot has become rigid, midfoot and triple arthrodesis may be the only reasonable surgical options left. The apex of the deformity is multiplanar and some deformities may have more-than-one apex. The-best outcomes are achieved with minimal shortening of the foot, so correction should be by rotation and translation and with minimal wedge resection wherever possible. In the past, persistent deformity and recurrence have been a major problem after correction of the rigid foot because of a lack of understanding of the importance of soft tissue balance. It is not enough to focus on the hindfoot even if this is where most of the deformity is present, and leaving the midfoot or forefoot alone is certain to result in recurrence. Posterior tibial tendon transfer and peroneus longus transfer are nearly always required for correction, and other soft tissue procedures (such as anterior tibial tendon transfer, plantar fascia release, tendo-achilles lengthening, and gastrocnemius slide) may be necessary as well. If the principles of soft tissue balancing are followed, arthrodesis is an excellent procedure despite the literature that states to the contrary.