In recent years, the therapeutic approach to treatment of cavovarus foot has become better established. Greater acceptance of the importance of the pronated forefoot is evident in most communications having to do with this unique and challenging deformity. The fact that the excessively plantar-flexed first ray is a significant element in the pathology of the condition is now well accepted. Whether it is the major or primary component of the problem is less well proven. If it is true that a fixed plantarfiexed first metatarsal produces a pronated forefoot then it logically follows that a flexible hind-foot during weightbearing will be forced into varus (or supination) as the result of the "tripod" effect. Eventually, with growth and adaptive changes, the hindfoot may gradually assume structural bony changes. The foot will then have two major therapeutic problems: a structural deformity in the forefoot (pronation), and a rigid hindfoot varus (supination).