Foot and ankle problems do not always present in black and white, but in shades of gray. We tend to put the conditions into categories or pigeonhole them into stages, but often the cases we treat are progressing through the stages and we may see cases in which stages are traversed. Staging assists in the decision-making process. It helps us choose a management option that is considered optimal for a stage. When there are different options for different stages and if the condition crosses stages, our decision-making faculties are taxed to their fullest. This is a key juncture where we benefit from the wisdom and experience of others who have been on the road the most. Among the conditions that have a potential to present in different shades of gray, rather than in the regimented stages to which we are attuned, is acquired symptomatic flat foot deformity. We are fortunate in having Jonathan Deland guest-edit a special issue on this condition. He is among those who have traveled the most on this road for the management of the condition. Along with his fellow travelers with similar experience, he has written on the subject here to deal with critical issues in management and help us find our way in the challenging situations in which the condition is among the shades of gray. I am confident that we will all pick up nuances and learn something new or reinforce our experience in these and in the articles that follow in this issue of the journal.
Vinod K. Panchbhavi, MD, FRCS, FACS