There are several forms of pes cavus with specific anatomical features and different outcomes. Medial pes cavus is often due to a neurological disorder and causes severe symptoms. The causal disease is responsible for gradual deepening of the arch and deformities of the toes and hindfoot. Surgery is warranted in severe deformities with functional impairment. Procedures performed in younger patients involve the soft tissues; an example is plantar release with or without osteotomy of the calcaneus. In older children, osteotomy or fusion is required.