A cavus foot is a foot with an unusually high arch. When the arch is very high the heel may also tip inwards, and this combination is called a cavovarus foot. Sometimes there is no obvious cause, but a high-arched foot is frequently linked to an inherited nerve condition such as Charcot-Marie-Tooth (CMT) disease. Over time an imbalance between the stronger and weaker muscles gradually pulls the foot into a fixed shape, and the outer border and ball of the foot become overloaded. This can lead to pain, repeated ankle sprains, difficulty finding comfortable shoes and hard skin or callus.

As a foot and ankle surgeon in London and North London, Mr Welck offers surgery for the high-arched foot when the shape of the foot is causing symptoms that have not settled with insoles, physiotherapy or bracing. This guide explains why the surgery is done, how to prepare, what the operation involves, and what recovery looks like.

The goal of cavus foot surgery is straightforward to describe: to place the foot flat and stable underneath the ankle. Surgeons sometimes summarise it as “putting the foot under the ankle, and the foot flat to the ground.” Achieving this balanced, level (“plantigrade”) foot brings a number of benefits:

• Pain relief — by unloading the painful outer border of the foot, the ball of the foot and the prominent first metatarsal.
• Better balance and fewer falls — correcting the inward heel position reduces the tendency to roll over on the ankle and repeatedly sprain it.
• Improved footwear and comfort — a foot that sits flat is far easier to fit into normal shoes.
• Healthier skin — reducing hard skin, callus and the risk of stress fractures of the fifth metatarsal caused by overloading the outer foot.
• A longer-lasting correction — rebalancing the tendons at the same time helps hold the foot in its new position and slows the deformity coming back.

A little preparation makes recovery much smoother. In the weeks before your operation it helps to:

• Get as fit and healthy as you can. If you smoke, stopping before surgery significantly improves wound and bone healing.
• Plan for a period of reduced mobility. You will be in a cast and unable to put weight through the foot at first, so arrange help at home, easy access to a bathroom, and ideally somewhere to sleep on the ground floor.
• Organise your walking aids. You will need crutches, and many people find a knee scooter easier for getting around while non-weightbearing.

Two items are worth buying in advance. A foam leg elevator makes it much easier to keep the foot raised above the level of your heart, which is the single most effective way to control swelling and pain in the early weeks. A waterproof cast protector — such as the “Limbo” — lets you shower without getting the cast or dressings wet, which keeps the wound clean and dry.

There is no single “cavus foot operation.” The correction is absolutely and essentially tailored to your foot, and usually combines several smaller procedures done through one anaesthetic. The most important question is whether your foot is flexible or rigid, because this changes the approach.

Most patients stay in hospital for one to two nights, though smaller corrections can sometimes be done as a day case and larger fusions may occasionally need a little longer. You will go home once your pain is well controlled and you are safe and confident on your crutches. You will leave with your foot in a cast or plaster, a supply of pain relief, and a follow-up appointment arranged.

Recovery from cavus foot surgery is a gradual process, and the timeline depends on whether you had a flexible (joint-preserving) correction or a rigid (fusion) correction. The protocols below reflect the aftercare Mr Welck uses; your own plan will be confirmed after surgery.

Cavus foot surgery is generally safe and most patients do well, but as with any operation there are risks. The most relevant risks specific to this type of surgery are:

• Wound-healing problems — blistering, minor (superficial) infection, slow healing or, less often, wound breakdown. The skin around the foot can be delicate, so wounds are watched closely.
• Numbness or nerve irritation — small nerves near the incisions can be bruised or stretched, occasionally leaving an area of numbness or tingling.
• Delayed or incomplete bone healing — an osteotomy or fusion can occasionally be slow to heal (delayed union) or fail to join fully (non-union), sometimes needing further treatment.
• Recurrence or under-correction — because the underlying nerve conditions that cause a cavus foot can be progressive, the deformity can partly return over time and occasionally further surgery is needed.
• Stiffness — expected after any fusion, and more noticeable if both the ankle and the hindfoot are fused.
• Uncommon problems — including complex regional pain syndrome (persistent pain and sensitivity, usually settling with time).

Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon based in London and North London, with an NHS practice at the Royal National Orthopaedic Hospital (RNOH), Stanmore, and private practice across the region. He is an Honorary Associate Clinical Professor at UCL and has a specialist interest in high-arched (cavovarus) foot correction, complex hindfoot reconstruction, ankle instability and ligament reconstruction, sports injuries and total ankle replacement, supported by weightbearing CT for detailed, personalised surgical planning.

To arrange a consultation with Mr Matthew Welck, please visit matthewwelck.com or use the details below.

• Telephone: 07547 395 270
• Email/contact form: matthewwelck.com/contact

This guide is for general information and does not replace individual medical advice. Please discuss your specific situation with your surgeon.