This JAAOS review by Bouchard and Mosca addresses the evaluation and management of flatfoot deformity in children and adolescents — specifically, which patients need treatment, which need surgery, and which procedure to choose. It synthesizes epidemiology, clinical examination pearls, imaging thresholds, and the evidence base (or lack thereof) for nonsurgical and surgical options.
When a child presents with flatfoot, your first job is reassurance — the deformity is almost always flexible, painless, and self-limiting, and orthotics won't reshape the foot.
When you see a painful flatfoot that fails prolonged nonsurgical management, look for an Achilles contracture (Silfverskiold test) and consider CLO as the reconstructive backbone, avoiding arthroereisis given its poor evidence and high complication rate.
This JAAOS review by Bouchard and Mosca addresses the evaluation and management of flatfoot deformity in children and adolescents — specifically, which patients need treatment, which need surgery, and which procedure to choose. It synthesizes epidemiology, clinical examination pearls, imaging thresholds, and the evidence base (or lack thereof) for nonsurgical and surgical options.
When a child presents with flatfoot, your first job is reassurance — the deformity is almost always flexible, painless, and self-limiting, and orthotics won't reshape the foot.
When you see a painful flatfoot that fails prolonged nonsurgical management, look for an Achilles contracture (Silfverskiold test) and consider CLO as the reconstructive backbone, avoiding arthroereisis given its poor evidence and high complication rate.