Management of the flexible flat foot in the child: a focus on the use of osteotomies for correction

Pes planus, commonly referred as flat foot, is a combination of foot and ankle deformities. When faced with this deformity in children, the treating surgeon should use a systematic method for evaluation to distinguish normal variation from true pathology, as well as conditions that have a benign natural history versus those that may lead to significant disability if left untreated. Certain deformities will inevitably worsen and therefore require surgery. Common sense clearly supports the indication for a simple procedure, such as an arthroereisis or an osteotomy, performed in the young child as opposed to an arthrodesis in older adolescence or adulthood as the foot becomes more rigid. Such approaches and other issues are discussed in this article.