Treatment of the calcaneocavus foot deformity

The calcaneocavus foot is almost always the result of a neural disorder and subsequent weakness of the triceps surae muscles. It is inexorably progressive, always disabling, and refractory to bracing. Therefore, treatment is directed toward the surgical correction of any existing deformity and the restoration of muscle balance. We developed a treatment approach based on goals and requirements that must be individualized according to the underlying neural disorder, the exact nature of the muscle imbalance, the degree of bone deformity, and the skeletal age of the patient. Nineteen calcaneocavus feet have been treated at our institution since 1958, with follow-up averaging seven and three-quarters years. The objective evaluation of the correction obtained was determined from a ratio computed by measurements on radiographs. All feet were improved according to this raio, although three were not corrected as well as was desired. An effort also was made to establish the amount of functional improvement as it was reflected in improved gait and push-off. These were largely subjective determinations, however, and although all patients demonstrated improved function, the amount of improvement was difficult to quantitate and none had normal function. There was a substatially consistent relationship between the improved objective and subjective result evaluations.