Cavovarus foot deformity in children has numerous etiologies with a general pathophysiologic mechanism of muscle imbalance. It is of great importance in the evaluation of a child with a cavovarus foot to determine the underlying cause of the deformity, as the most common origin is a progressive neurologic condition that may be complicated by other orthopedic problems. Treatment options typically are surgical, with limited indications for nonsurgical modalities, and must consider the age of the patient, the nature of the neurologic disease, and the severity of the deformity. Current surgical procedures can be divided into soft tissue procedures to rebalance the muscle forces, osteotomies, and triple arthrodesis. Triple arthrodesis is considered a salvage procedure reserved for the older child with severe, rigid deformity who has failed other surgical treatments.