Cavus Foot Reconstruction
A high arched foot is known as a 'pes cavus.' It can be normal, occurring in 10 percent of the population. However, the deformity in some patient populations such as those with Charcot-Marie-Tooth disease, and other neuromuscular conditions can be severe enough to warrant surgery.
Why have the surgery?
A high arched foot places changes the areas where stress is absorbed through the foot, when standing or walking. This can lead to pain, stress fractures, skin breakdown and ankle instability. If these symptoms relate to the high arch, then surgery to correct the foot shape can lessen these problems.
How is surgery performed?
The operation is typically performed under a general anaesthetic. The type of surgery will vary according to aetiology and severity of deformity. Multiple incisions are typically needed to access the various soft tissues, bones and joints. The various components of the operation can include: - Tendon lengthening - Tendon transfer, which means using a functioning muscle to provide an alternative movement to that which it may originally intended to do - Osteotomy, which means cutting a bone and reorientating it. The most common osteotomy is performed to the heel bone to change it from pointing inwards to pointing outwards. - Fusion, which means surgically joining two or more bones into a single bone. This is indicated when arthritis or severe deformity occurs.
What are the benefits?
Correcting the foot shape and balancing the soft-tissues can reduce and redistribute the forces going through the foot. This in turn can make standing, walking and wearing shoes more comfortable.
What are the risks?
All operations have risks, but the commonest and most concerning for this surgery are: - Non-union, meaning that the bone does not heal and the pain continues. - Arthritis occurring in the surrounding joints, since the stiffness at the ankle joint can place extra stress on the other mobile joints and leads to them wearing out over time. - Blood clots, which can form in the leg and travel up to the lung where they can be fatal. This list is not exhaustive and Mr Patel can talk you through them all in more detail during a consultation.
What recovery is involved?
The recovery is dependent upon the cause and severity of the deformity, which in turn dictates how simple or extensive surgery needs to be. At a minimum, patients will spend six weeks in plaster, but may spend up to three months in plaster if complex procedures such as a 'wedge-tarsectomy' is needed. Physiotherapy is then needed to restore strength and balance with full recovery taking up to one year.
Any other considerations?
Many patients will think that once the ankle is fused, they will not be able to move the foot. It is important to appreciate that the up and down motion that occurs when walking is combination of the foot and ankle moving, and often it is not possible for an observer to see which ankle has been fused when a patient walks.