Younger and Hansen's 2005 JAAOS review addresses the evaluation and surgical management of adult cavovarus foot deformity across all major etiologies — neurologic, traumatic, residual clubfoot, and idiopathic — asking how clinicians should systematically diagnose and correct the underlying muscle imbalance and fixed deformity to prevent progressive joint destruction.
When you see an adult with high arch, hindfoot varus, and lateral foot overload, perform the Coleman block test first: if the heel corrects, address the forefoot (first-ray osteotomy ± tendon transfer) and you're done with the hindfoot; if it doesn't correct, add a lateralizing calcaneal osteotomy or subtalar fusion.
Don't defer surgery indefinitely with bracing — untreated muscle imbalance is progressive and leads to fixed deformity that requires fusion rather than the joint-preserving reconstruction still possible early in the disease course.
Younger and Hansen's 2005 JAAOS review addresses the evaluation and surgical management of adult cavovarus foot deformity across all major etiologies — neurologic, traumatic, residual clubfoot, and idiopathic — asking how clinicians should systematically diagnose and correct the underlying muscle imbalance and fixed deformity to prevent progressive joint destruction.
When you see an adult with high arch, hindfoot varus, and lateral foot overload, perform the Coleman block test first: if the heel corrects, address the forefoot (first-ray osteotomy ± tendon transfer) and you're done with the hindfoot; if it doesn't correct, add a lateralizing calcaneal osteotomy or subtalar fusion.
Don't defer surgery indefinitely with bracing — untreated muscle imbalance is progressive and leads to fixed deformity that requires fusion rather than the joint-preserving reconstruction still possible early in the disease course.