Paediatric Flexible Flatfeet: A Narrative Review of Conflicting Perspectives in Clinical Practice

Paediatric flexible flatfoot (PFF), though common, lacks universally accepted diagnostic and management protocols. There is ongoing debate regarding whether it represents a pathological condition or a physiological variant. Whilst many children remain asymptomatic, evidence suggests that even those without overt symptoms may experience reduced functional capacity.

This narrative review aims to summarise the current understanding of paediatric flexible flatfoot, focusing on factors influencing arch development and the various clinical approaches used in managing symptomatic children.

Many treatment strategies have been described in literature for symptomatic children, including non-operative measures such as orthotic support and functional re-education, as well as surgical procedures such as lateral column lengthening and subtalar arthroereisis (SA).Obesity has been identified as a significant contributing factor to paediatric flexible flatfoot. With the expected rise in childhood obesity, the prevalence of flatfoot is likely to increase, highlighting the need for clear and standardised management guidelines.

Paediatric flexible flatfoot remains a debated condition with no clear consensus regarding its clinical significance or optimal management. While most children remain asymptomatic, symptomatic cases should initially be managed with activity modification and functional re-education. Surgical procedures such as subtalar arthroereisis show promising short-term outcomes in selected patients, though further long-term studies are required to establish clear treatment guidelines.