An algorithmic approach to evaluation of the flatfoot. Avoidance of pitfalls

The authors have attempted to lead the reader through a comprehensive and systematic diagnosis of the patient with the flatfoot. The authors followed the familiar SOAP format. Within each of the major steps (subjective findings, objective findings, assessment, and plan) a systematic algorithm is proposed. These are designed with the objective of comprehensively evaluating the patient. This should dissuade the reader from myopically approaching the flatfoot, and potentially missing comorbid or etiologic systemic disease. A brief introduction to a systematic treatment philosophy is also presented. Unfortunately exhaustive discussion of each of the steps would require a separate article. The authors hope that the controversies highlighted will stimulate further research into this subject. It is also hoped that anyone approaching the patient with flexible flatfoot would avoid some of the dogmatic philosophies that have plagued this subject. Until well-developed scientific research answering the basic questions is done, all currently available approaches are based on opinion and personal bias.