Management of Flexible Flatfoot in Chidren and Adolescent

Sun Young Joo; Jung Ryul Kim

doi:10.4055/jkoa.2016.51.2.109

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Joo and Kim: Management of Flexible Flatfoot in Chidren and Adolescent

Symposium

Common Problems in Skeletally Immature Patients

Journal of the Korean Orthopaedic Association 2016; 51(2): 109-116.

Published online: 22 April 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.2.109

Management of Flexible Flatfoot in Chidren and Adolescent

Sun Young Joo, M.D., Jung Ryul Kim, M.D.^*

Department of Orthopedic Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea.

^*Department of Orthopedic Surgery, Chonbuk National University Medical School, Jeonju, Korea.

Correspondence to: Jung Ryul Kim, M.D. Department of Orthopedic Surgery, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea. TEL: +82-63-250-1767, FAX: +82-63-271-6538, jrkeem@chonbuk.ac.kr

Received 3 July 2015 Revised 17 November 2015 Accepted 4 February 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Most children and adolescents with flexible flatfeet are asymptomatic and most do not require treatment. Scant convincing evidence exists to support the use of inserts or shoe modifications for effective relief of symptoms, and there is no evidence that those devices change the shape of the foot. Surgical correction is indicated for failure of prolonged nonsurgical attempts to relieve pain that interferes with normal activities and occurs under the medial midfoot and/or in the sinus tarsi. Osteotomies with supplemental soft-tissue procedures or arthroereisis are the suggested operative procedures for symptomatic flatfoot. An associated contracture of the heel cord is present in nearly all cases. Concurrent rigid forefoot supination deformity should be addressed as well.

Keywords: flexible flatfoot, child, management

Figures and Tables

Figure 1

(A) Clinical photograph of the foot demonstrating flexible flatfoot deformity. (B) An arch is created in a flexible flatfoot by the windlass action of the great toe and plantar fascia (Jack toeraise test).

Figure 2

A valgus hindfoot (A) and restoration of hindfoot varus (B) when the patient stands on the toes.

Figure 3

Clinical photograph demonstrating the Silfverskiöld test. The subtalar joint must be held in neutral position with the knee extended for accurate assessment of ankle dorsiflexion between the plantarlateral border of the foot and the anterior tibial shaft.

Figure 4

Clinical photograph and lateral radiograph of the foot taken preoperatively (A) and after calcaneal lengthening osteotomy (B) show improvement of the foot alignment.

Figure 5

Clinical photograph and lateral radiograph of the foot taken preoperatively (A) and after triple C osteotomy (B) show improvement of the foot alignment.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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