Flexible Flatfoot

  • Little or no longitudinal arch
  • Flat but flexible & not known to have effects in adult life
  • shape of the foot during weight bearing is primarily due to osseous & ligamentous structure with the muscles performing a secondary role

Natural History

  • 97% of children have flat arch at age 2, 4% at age 10
  • Never proven to be a problem

Clinical Features

  • Longitudinal arch reappears when extending great toe in non weight bearing situation
  • Examine the subtalar joint while supinating the forefoot
  • Examine midtarsal joint
  • Examine tendo Achilles
  • Torsional evaluation

Investigations

  • Only if question of rigidity
  • Look at the talocalcaneal angle on the AP & Lat
  • Talus tends to plantar flex

Treatment

  • Nonoperative
    • No evidence for shoes or arch supports
  • Operative
    • If painful look for a cause
    • Not in the growing child
    • Rare recalcitrant painful adolescent with pain over the talar head, consider calcaneal lengthening