What is Cavovarus Foot?
To support the entire body’s weight on your two feet, the inner middle portion of each foot (midfoot) is raised off the ground to form an arch. A cavovarus foot deformity is characterized by a higher-than-normal arch of the inner midfoot. This results as the two ends of the foot - the heel and toes - abnormally draw towards the inside of the foot, causing the foot to rest on its outer side. This deformity produces pain in the heel, ball of the foot and outer edge of the foot, instability of gait, frequent ankle sprains, difficulty wearing shoes, callus formation and sometimes stress fractures in the bones on the outer side of the foot.
What are the Causes of Cavovarus Foot?
The cause for cavovarus foot deformity is usually unknown, but it may be associated with neuromuscular conditions such as Charcot-Marie-Tooth disease (progressive muscle weakness), stroke, head injury and poliomyelitis (viral infection that causes paralysis). It may be produced by an imbalance in the strength of the foot muscles, causing muscle contractures (stiffness) or due to bony deformities of the heel bone.
How is a Cavovarus Deformity Corrected?
Cavovarus deformity may be corrected by conservative methods:
- Bracing, to help with ankle instability and sprains
- Shoe inserts, to raise the lateral border of the foot and accommodate the middle region of the foot
If cavovarus deformity is not adequately controlled by conservative means, your doctor will recommend surgical treatment.
Cavovarus Foot Reconstruction
Cavovarus foot reconstruction surgery typically involves bone, tendon, and/or ligament reconstruction to restore the foot to a normal position. The main objective of this reconstructive surgery is to realign the heel bone, decrease the height of the arch, and improve the way the foot moves by rebalancing tendons that move the foot.
Indications for Cavovarus Reconstruction
Your surgeon may recommend cavovarus foot reconstruction when your cavovarus foot has been causing a lot of pain, rubbing on your shoes such that the skin breaks down, or when your foot or ankle is very unstable, and conservative treatment measures such as medications, stretching exercises, and foot orthotics have failed to relieve symptoms and correct the foot deformity associated with Cavovarus.
Preparation for Cavovarus Reconstruction
Preparation for cavovarus reconstruction surgery may involve the following steps:
- A review of your medical history and physical examination is performed to check for any medical issues that need to be addressed prior to the surgery.
- You may also need to undergo diagnostic tests such as blood work to help detect any abnormalities that could compromise the safety of the procedure and imaging of the foot to plan the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of current medications or supplements you are taking, or any recent illnesses or conditions you have such as heart or lung disease.
- Your physician may alter the dosage of your medications or ask you to stop taking certain medications, such as blood thinners for a defined period if contraindicated for the procedure.
- You should refrain from alcohol and tobacco for at least a few days prior to surgery and several weeks after, as these can hinder the healing process.
- You should not consume any solids or liquids at least 8 hours prior to the surgery.
- You should arrange for someone to drive you home after the procedure.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.
Procedure for Cavovarus Reconstruction
Cavovarus reconstruction surgery may involve a combination of procedures to reconstruct the cavovarus foot. In general, the foot reconstruction surgery may involve the following:
- You will be placed in a supine (face-up) or a prone (face-down) position on the procedure table with your foot held in an optimal position to facilitate surgery.
- You will typically be administered a general or spinal anesthetic so that you remain asleep throughout the procedure and do not feel any pain during the surgery.
- The surgical site is cleaned with an antiseptic solution and incisions are made along the site of operation.
- Retractors are used to move the muscles away from the operative area and provide access to the bones and internal soft tissues in the foot.
- Based on your specific foot deformity, your surgeon may carry out any of these procedures or a combination of these procedures:
- Tendon release: In this procedure, a tendon is cut or disconnected to increase the range of movement. The commonly targeted tendons include the Achilles tendon and plantar fascia. The deltoid ligament or the ankle ligament may also be incised to help in tendon release.
- Osteotomy: In this procedure, the bones in the foot and ankle joint are cut and shaped to give them a more natural appearance.
- Arthrodesis: In this procedure, two or more bones are fused together to provide stability and shape to the foot and ankle joint.
- Claw toes and hallux cock-up corrections may also be performed at this time.
- Fixation devices such as wires, pins, or plates may be used to stabilize the bones and keep them in place.
- Once the foot has attained the desired alignment and appearance, your surgeon closes the incisions.
- The incisions may be covered with a waterproof dressing to keep the incision site clean and dry.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after cavovarus reconstruction surgery will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may notice pain and swelling in the treated area. Medications are provided as needed to address these.
- Antibiotics are also prescribed to address the risk of surgery-related infection.
- You are advised to keep your leg elevated as much as possible while resting to prevent swelling and pain.
- Do not weight-bear on the operated leg. Assistive devices such as crutches or walkers are recommended throughout the healing period to support the foot.
- You may be told to use a cast, brace, or splint along with orthotic shoes for a specific period to ensure a safe recovery and prevent deformity recurrence.
- You will be started with physical therapy to strengthen your foot muscles and improve your range of motion once you are off assistive/orthopedic devices.
- Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities for at least 6 months. A gradual increase in activities is recommended, with your doctor’s guidance.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
As with any surgical procedure, cavovarus foot reconstruction may also carry some risks and complications, such as:
- Pain or swelling at the operation site
- Damage to the surrounding tissues
- Delayed recovery
- Side effects of anesthesia
- Blood clots or deep vein thrombosis (DVT)
- Need for revision surgery