Review Question - QID 30

The photograph demonstrates bilateral cavovarus foot orientation. Cavovarus positioning of the foot leaves the ankle susceptible to inversion sprains and lateral ligament attenuation. The radiograph shows a calcaneal pitch consistent with cavovarus deformity and no evidence of degenerative change. Initial conservative treatment should include orthotics with a recessed first metatarsal, lateral forefoot wedge, reduced arch, and heel wedge. Failure of conservative treatment is an indication for surgery. The lateral ligament reconstruction must be augmented with an osteotomy to correct the cavovarus deformity or it will be very prone to failure. The flexible deformity (as demonstrated by Coleman block testing) suggests successful correction with a metatarsal osteotomy as opposed to a calcaneal osteotomy which would be reserved for a rigid deformity.

Fortin et al review 13 cases of chronic lateral ankle instability with cavovarus foot deformity. Ankles with significant degenerative changes were treated with arthrodesis. Ankles without degenerative changes were treated with lateral ligament reconstruction with calcaneal and/or first metatarsal osteotomies to correct the cavovarus deformity.