Pes cavovarus is a complex foot deformity typically characterised by an abnormally high medial longitudinal arch, hindfoot varus, and clawed toes. It can result from neurological disorders, trauma, or idiopathic causes, and leads to progressive instability, pain, and difficulty in ambulation. This chapter will explore the surgical reconstruction options that should restore a balanced foot by addressing both the bony and soft tissue abnormalities. Procedures may include soft tissue releases, osteotomies, tendon transfers and, in severe cases, midfoot or hindfoot fusions. Fusions will be covered elsewhere in this textbook. There is no one single cocktail of procedures for patients with this pathology, and the different surgical strategies used are individualised to each patient based on the severity, flexibility, and underlying etiology of the deformity. This chapter provides an overview of pes cavovarus reconstruction, detailing the indications, surgical techniques, and postoperative management strategies to achieve optimal alignment, stability, and function.