ABSTRACT
It is a complex three-dimensional structure held in shape by the delicate balance of the intrinsic and extrinsic muscles. In a forefoot driven cavovarus foot, early clinical problems can be from overloading of the first metatarsal head area, resulting in a plantar callosity, sesamoid disease or early hallux rigidus. For balancing purposes, the authors would recommend using equal height blocks under both feet simultaneously. A wide range of potential operations are described in literature which can be daunting. Clawing of the great toe can be rebalanced by the Jones procedure, which involves transfer of EHL to the first metatarsal neck and stabilisation of the interphalangeal joint by fusion in a straight position. Most patients with a pes cavus have a foot drop and a weak tibialis anterior muscle.
