Updated Review of Surgery for Pes Cavus Foot Deformity

In the 1970s, Dr. D. S. Weiner, a pediatric orthopedic surgeon, developed a surgical technique to manage rigid pes cavus deformity of the foot. In lay terms, the rigid cavus foot has a very high arch. It is not flexible, so most of the foot doesn’t touch the floor when standing.

Over the years, Dr. Weiner reported on the results of this operation. This is the third published study of results of patients treated with the Akron dome midfoot osteotomy. This procedure addresses the deformity from more than one plane. It corrects the longitudinal (lengthwise) arch and the transverse (crosswise arch.

All children in the study had complex cases with rigid bone position. Dr. Weiner and his associates present details of other procedures used to treat this deformity. The major drawback of other operations was their failure to correct all planes. Step-by-step details of the Akron technique were also provided.

In this study, each patient was evaluated individually. Modifications to the Akron approach were made based on the presence of muscle balances and age of the child. Age is important because it reflects the skeletal maturity of the child. Children with neurologic conditions such as cerebral palsy or Charcot-Marie-Tooth syndrome were also treated with the Akron procedure. For the neurologic patients, the surgery included releasing some of the soft tissues along the bottom of the foot.

Results were satisfactory in three-fourths of the cases. Satisfactory was defined as pain free and at least 75 per cent of the foot was touching the floor. There were no abnormal areas of pressure on the foot.

Older children (eight years old and older) were more likely to have a good result without recurrence of the problem. The authors suggest that when the child’s age is closer to skeletal maturity, there is less room for change with growth. But surgery can’t always be delayed when pain or pressure ulcers are present.

The results of the studies of the Akron dome midfoot osteotomy over the past 40 years show that it is a valuable salvage procedure for a rigid pes cavus foot. Salvage refers to the fact that other treatment has been tried and failed. This approach provides a more functional foot position and reduces the risk of ulcers from too much pressure.