Sullivan's 1999 narrative review systematically addresses how to evaluate and manage pediatric flatfoot, from the benign calcaneovalgus deformity of newborns through pathologic conditions — congenital vertical talus, tarsal coalition, and skewfoot — that require specific intervention. The central question: which children actually need treatment?
When a parent brings in a child with flat feet, your job is to rule out rigid or painful pathology — congenital vertical talus, tarsal coalition, skewfoot — not to treat the arch.
If the foot corrects on tiptoe and the subtalar joint moves freely, it's flexible flatfoot: reassure the family, avoid expensive orthotics of unproven benefit, and do not operate unless pain fails all conservative measures.
Sullivan's 1999 narrative review systematically addresses how to evaluate and manage pediatric flatfoot, from the benign calcaneovalgus deformity of newborns through pathologic conditions — congenital vertical talus, tarsal coalition, and skewfoot — that require specific intervention. The central question: which children actually need treatment?
When a parent brings in a child with flat feet, your job is to rule out rigid or painful pathology — congenital vertical talus, tarsal coalition, skewfoot — not to treat the arch.
If the foot corrects on tiptoe and the subtalar joint moves freely, it's flexible flatfoot: reassure the family, avoid expensive orthotics of unproven benefit, and do not operate unless pain fails all conservative measures.