Planar dominance. A major determinant in flatfoot stabilization

For treatment of a symptomatic flat foot in a child or an acquired flatfoot from posterior tibial dysfunction in the adult, an understanding of the biomechanics and function of the foot and leg is essential to achieve an excellent outcome. Evaluation of supramalleolar deformity directly influences the procedure choice and eventual success of the procedure. An understanding of the level of deformity also indicates the procedure to be used. Subtalar and midtarsal joint function, although related, have their own primary source of deformity. Correction through the subtalar and midtarsal joints must be individualized. Augmentation of the primary repair must be performed when overall instability is present, such as an elongated or deformed posterior tibial tendon or medial ligamentous structure. Evaluation of the gross deforming force of the triceps suri also must be evaluated to provide and ensure predicted outcomes.