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Management of the Painful Adolescent Flatfoot

Mosca, Vincent S. MD*,†

Techniques in Foot & Ankle Surgery: March 2014 - Volume 13 - Issue 1 - p 3–13
doi: 10.1097/BTF.0000000000000035
Special Focus: Surgical Treatment of Symptomatic Flatfoot Deformity

Flexible flatfoot (FFF) is a normal foot shape that is present in most infants and many adolescents and adults. The arch elevates spontaneously in most children during the first decade of life. There is no evidence that a longitudinal arch can be created in a child’s foot by any external forces or devices. FFF with a short Achilles tendon, in contrast to simple FFF, is known to cause pain and disability in some adolescents and adults. Joint-preserving, deformity-correcting surgery is indicated in flexible flatfeet with short Achilles tendons when conservative measurements fail to relieve pain under the head of the unyielding plantar flexed talus or in the sinus tarsi area. The calcaneal lengthening osteotomy has been shown to most reliably correct all components of hindfoot valgus/eversion deformity at the site of deformity and relieve symptoms. In almost all cases, Achilles tendon or gastrocnemius tendon lengthening is required. In some cases, rigid supination deformity of the forefoot is present, requiring identification and concurrent correction.

*Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine

Seattle Children’s Hospital, Seattle, WA

The author declares no conflict of interest.

Address correspondence and reprint requests to Vincent S. Mosca, MD, Seattle Children’s Hospital, 4800 Sand Point Way, NE, P.O. Box 5371/W-7706, Seattle, WA 98105-0371. E-mail:

© 2014 by Lippincott Williams & Wilkins