Cavus Foot Reconstruction Treatment Offered in Baltimore

There are many causes for a high arch foot, known as cavus. In the United States, the most common cause for a high arch foot is a form of muscular dystrophy called hereditary sensorimotor neuropathy, more commonly known as Charcot Marie Tooth disease (CMT). 

Surgery to correct cavus foot may be necessary in situations where the symptoms are likely to get worse over time or when pain and instability cannot be corrected with external orthopedic devices. The main goals of surgery are:

• Correcting all the existing deformity of the toes, the high arch, the ankle and the muscle imbalance
• Preserving as much motion as possible
• Rebalancing the deforming muscle forces around the foot and ankle
• Adding stability to the ankle
• Preventing ankle arthritis from occurring as a result of the chronic deformity of the foot and the instability of the ankle 

There are many types of surgical procedures that can be performed to correct the cavus foot and restore function and muscle balance. The decision as to which surgery is done depends on the underlying deformity and the pattern of muscle loss and weakness. Our foot and ankle surgeons study each patient individually and develop a specific plan based on the parts of the foot and ankle that are involved. The foot can be divided into four main areas:

• Forefoot (including the toes)
• Midfoot (including the arch)
• Hindfoot (including the heel)
• Ankle

There is always a combination of many procedures that is done all at the same time to correct the various deformities. Occasionally, the surgery has to be staged in two sessions so that the hindfoot and ankle are first corrected followed by the toes. The surgeries can be:

• Tendon transfers to correct muscle weakness
• Bone cuts (called osteotomies) to correct bone deformity
• Soft tissue releases to reposition the arch of the foot

Any and all of the four main areas of the foot can be affected by cavus deformity or CMT. Generally, a combination of a calcaneal (hindfoot) osteotomy, a first metatarsal (forefoot) osteotomy, and a plantar fascia (the thick connective tissue on the bottom of the foot that helps support the arch) release is performed. Occasionally, additional bone cuts (including midfoot osteotomies) and soft tissue procedures (including ankle ligament reconstruction and tendon transfers) are necessary to complete the correction. 

As a rule, the surgeons at The Institute for Foot and Ankle Reconstruction at Mercy try to avoid performing a fusion (called an arthrodesis) of the foot if at all possible. In some severe deformities or in cases that involve significant arthritis, certain joints may need to be fused using plates, screws or pins to help decrease pain and correct the deformity. 

Unfortunately, this means that some motion in the foot and ankle will be lost permanently. Yet this does not necessarily compromise the patient’s ultimate function. Examples of joint fusion (called arthrodesis) procedures include ankle arthrodesis (which limits up and down motion of the foot) and triple arthrodesis (meaning that three separate joints of the hindfoot are fused together, limiting side to side motion).

The correction of cavus feet and CMT can be challenging. However, with appropriate care and management, the foot usually can be well corrected and balanced with as much motion as possible maintained. The foot and ankle surgeons at Mercy are experts at performing cavus foot reconstruction and work with each patient to determine which surgical procedure is the best treatment option.