Surgical management of the flatfoot

The flatfoot in a child with sufficient deformity and symptoms to warrant surgery occurs infrequently. A prolonged trial of nonsurgical measures is always indicated. With the exception of the spastic paralytic foot, surgery involving alteration of the bony anatomy should be postponed until the child's foot matures. Restoration of the longitudinal arch at the midfoot naviculocuneiform articulation is a reliable solution to the symptomatic hypermobile flatfoot. The spastic paralytic foot requires tendo Achillis lengthening, medial imbrication, and Grice subtalar stabilization. The symptomatic, cartilaginous tarsal coalition will respond to resection. Treatment of the skewfoot must be individualized depending on the severity and location of symptoms, age of the patient, and joint mobility.