How to manage pes cavus in children and adolescents?

Pes cavus in its different forms is not a pathological entity, but rather the manifestation of multiple diseases.Cavovarus, a form of cavus foot, should never be considered a physiological deformity. A neurological condition should always be excluded.The evolution of pes cavovarus is unpredictable because of the large number of conditions involved in its aetiology, as well as their variable degree of expression. About 66% of cavovarus feet are the result of subtle neurological diseases, which only become evident later in life.Although surgery may not change quality of life, recent studies suggest that it may improve foot posture and reduce walking instability.The aim of treatment is to preserve a painless, plantigrade, mobile foot. Management consists of correcting bone deformity while preserving movement, and the wise use of rebalancing techniques. Arthrodesis should only be a salvage procedure. Cite this article: 2021;6:510-517. DOI: 10.1302/2058-5241.6.210021.