[Flexible flatfoot in children--a controversial subject]

Area of Science:

• Pediatric Orthopedics
• Developmental Pediatrics

Background:

• Flexible flatfeet are common in children, with incidence rates varying widely (3-90%) based on evaluation methods.
• Higher prevalence reported by non-orthopedic specialists suggests potential overdiagnosis.

Purpose of the Study:

• To review current opinions on flexible flatfeet in children.
• To discuss the classification, natural history, and management of flexible flatfeet.
• To address the trend of over-treatment and its consequences.

Main Methods:

• Review of current literature and expert opinions on pediatric flexible flatfeet.
• Classification of flexible flatfeet into developmental and static types.
• Analysis of treatment outcomes and long-term effects.

Main Results:

• Developmental and static flexible flatfeet in children generally do not require treatment and resolve spontaneously or are associated with benign soft tissue laxity.
• Over-treatment with exercises, inserts, or special shoes is common, leading to costs, ineffectiveness, and psychological distress.
• Persistent flexible flatfeet do not negatively affect adult quality of life.
• Gastrocnemius muscle or Achilles tendon shortening can lead to hindfoot valgus, which may require surgical intervention.

Conclusions:

• Flexible flatfeet in children are often over-treated, despite evidence suggesting they are benign and do not require intervention.
• Non-operative management is generally not indicated for flexible flatfeet.
• Surgical treatment may be considered for associated hindfoot valgus deformity secondary to muscle or tendon shortening.