PCS cavus is represented by downturn of the forefoot vis-a-vis the hindfoot, with the summit at the cuneonavicular. Occasional secondary signs include hindfoot inversion, talipes equinus, and claw toes. The deformity usually presents at the age of 7-8 yr. In the adolescent and adult, the clinical signs are metatarsalgia, painful callosity of the claw toes, instability of the hindfoot, and painful arthrosis. The onset of metatarsalgia is an expression of gradual stabilisation. With respect to its site, it offers an indication of the type of deformity in relation to its components; M. I or I-II, main component is medial downturn of the forefoot; M. II-III or II-III-IV round forefoot; M. IV-V or V inversion of the calcaneus; M. I-V, talipes transversocavus; M. total, t. equinus. The pathogenesis of clawtoe cannot always be determined without difficulty. In some cases, it is the consequence of failure of the interosseals and the lumbricales pedis to perform their function as flexors of the proximal phalanx and extensors of the distal (clawtoe in pes cavus). In other cases, a drop of the metatarsi into equinus, due to retraction of the plantares breves, compels the interosseals and lumbricales to arrange themselves dorsally at the centre of rotation of the head of the metatarsi and invert their function, and so extend the proximal phalanges? As a result the distal phalanges enter into flexion owing to tension of the corresponding flexors (clawtoe due to contracted foot). Rapid stabilisation is usual in both cases. There are three clinical pictures: proximal clawfoot, flexion of the medial phalanx on the proximal, this being extended on the corresponding metatarsus; distal clawtoe, flexion of the distal phalanx on the medial normally set on the proximal; gooseneck toe, proximal clawtoe plus hypertension of the distal phalanx on the medial. In other cases, clawtoe reflects a compensation mechanism only during walking (functional clawtoe, with spontaneous correction associated with correction of the primary functional alteration): in the oscillating stage, as a consequence of TA failure substituted by the extensor digitorum, or, in the impact or take-ofT stage, failure of the triceps substituted by the flexor longus. Lastly, there is some support for the view that clawtoe (stabilised or not) may lead to verticalisation of the metatarsi owing the a change in muscle play (pes cavus due to pied en grific). Inversion of the calcaneus may be primary, or secondary due to compensation for pronation of the forefoot. It is clear that the forefoot is of importance in the overall context of talipes cavus, and also with regard to the chronological progression of the deformity: proximodistal (tarsus-metatarsus-toes; tarsus +metatarsus-toes); distoproximal (toes-metatarsus-tarsus; toes + metatarsus-tarsus); intermedio-disto-proximal (toes-metatarsus-tarsus). Surgery, depending on the situation, must be directed to the forefoot, hindfoot and toes, possibly with additional management. The best guided and most resolutive treatment will be the outcome of careful evaluation of the prior history and the deformity, the use of instrumental symptomatology, and the indications of the neurological specialist.