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Flatfoot is one of the most common musculoskeletal conditions in the daily practice of pediatric orthopedists. Despite of numerous studies, diagnostic criteria and principles of management remain controversial. Flexible flatfoot - is visually detectable decrease in the height of the longitudinal arch of the foot, which can be spontaneously corrected by active or passive motion and not accompanied by any contracture of foot and ankle. Flexible flatfoot is a benign condition which is normal for childhood. But this term is also used to describe a painful deformity with marked limitation of dorsiflection and “not physiological” flatfoot with unfavorable course and prognosis. Despite of the awareness of the parents, flexible flatfoot does not lead to pain and should not be followed by any kind of treatment. Special shoe modifications and orthopedic insoles are useless in the attempt to improve the foot, but can influence negatively psychological condition and self-estimation. Proper diagnosis of flexible flatfoot is necessary in order to avoid unnecessary treatment and to reveal patients with adverse prognosis and rigid forms of flatfoot which need special approach.

About the authors

Vladimir Markovich Kenis

FSBI “Scientific and Research Institute for Children’s Orthopedics n. a. G. I. Turner” under the Ministry of Health of the Russian Federation

Email: kenis@mail.ru
MD, PhD, head of the department of foot pathology, neuroorthopedics and systemic diseases.

Yurii Alexeevich Lapkin

FSBI “Scientific and Research Institute for Children’s Orthopedics n. a. G. I. Turner” under the Ministry of Health of the Russian Federation

Email: omoturner@mail.ru
MD, PhD, leading research associate of scientific organizing department.

Ruslan Khalilovich Husainov

FSBI “Scientific and Research Institute for Children’s Orthopedics n. a. G. I. Turner” under the Ministry of Health of the Russian Federation

Email: drhuslan@gmail.com
MD, PhD student of the chair of Pediatric traumatology, orthopedics and surgery

Andrei Viktorovich Sapogovskiy

FSBI “Scientific and Research Institute for Children’s Orthopedics n. a. G. I. Turner” under the Ministry of Health of the Russian Federation

Email: sapogovskiy@gmail.com
MD, orthopedic surgeon of the department of foot pathology, neuroorthopedics and systemic diseases


  1. Болтрукевич С. И. Корригирующий латеральный артрориз подтаранного сустава для лечения нефиксированной формы плоскостопия у детей: инструкция по применению // Гродно. 2011. С. 32.
  2. Ефимов А. П. Клинически значимые параметры походки / А. П. Ефимов // Травматология и ортопедия России. 2012. 63. № 1. С. 60-65.
  3. Лапкин Ю. А., Кенис В. М. Варианты статической плоско-вальгусной деформации стоп тяжелой степени у детей / Материалы II Евразийского конгресса и II съезда травматологов-ортопедов Кыргызстана // Медицина Кыргызстана. 2011. № 4. С. 176.
  4. Садофьева В. И. Рентгено функциональная диагностика заболеваний опорно-двигательного аппарата у детей. Л.: Медицина, 1986. 240 с.
  5. Храмцов П. И. Функциональная стабильность вертикальной позы у детей в зависимости от свода стоп / П. И. Храмцов, А. М. Курганский // Вестн. Росс. акад. мед. Наук. 2009. № 5. С. 41-4.
  6. Aharonson Z. Foot-ground pressure pattern of flexible flatfoot in children, with and without correction of calcaneovalgus / Aharonson Z, Arcan M. Clin Orthop. 1992; 278:177-182.
  7. Basmajian J.V. The Role of Muscles in Arch Support of the Foot an electromyographic study/ J. V. Basmajian, G. Stecko. The Journal of Bone & Joint Surgery. 1963; 45:1184-1190.
  8. Bertani A. Flat foot functional evaluation using pattern recognition of ground reaction data/ A. Bertani [et al.]. Clinical biomechanics (Bristol, Avon). 1999; 14(7):484-93.
  9. Bleck E.E. Conservative management of pes valgus with plantar flexed talus flexible / E. E. Bleck, U. J. Berzins. Clin. Orthop. 1973;125: 85.
  10. Brewerton D.A. «Idiopathic» pes cavus: an investigation into its aetiology / D. A. Brewerton [et al.]. British medical journal. 1963; 2:659-661.
  11. Cavanagh P.R. The arch index: a useful measure from footprints / P. R. Cavanagh, M. M. Rodgers. Journal of biomechanics. 1987; 20(5):547.
  12. Chang J. H. Prevalence of flexible flatfoot in Taiwanese school-aged children in relation to obesity, gender, and age / J. H.Chang [et.al.]. Eur J Pediatr. 2010; 169(4):447-52.
  13. Christopher Rose R.E. Flat feet in Children: When should they be treated / R. E. Christopher Rose. Flat feet in Children: When should they be treated. 2006; 5(1).
  14. Cicchinelli L.D. Analysis of gastrocnemius recession and medial column procedures as adjuncts in arthroereisis for the correction of pediatric pes planovalgus: a radiographic retrospective study / L. D. Cicchinelli [et al.] J Foot Ankle Surg. 2008; 47(5):385-91.
  15. Cook D.A. Observer variability in the radiographic measurement and classification of metatarsus adductus / D. A. Cook [et al.]. Journal of pediatric orthopedics. 1992;12(1):86-89.
  16. Cowan D.N. Foot morphologic characteristics and risk of exercise-related injury/ D. N. Cowan [et al.]. Archives of family medicine. 1993;2(7):773-777.
  17. Dogan A. The results of calcaneal lengthening osteotomy for the treatment of flexible pes planovalgus and evaluation of alignment of the foot / A. Dogan [et al.]. Acta orthopaedica et traumatologica turcica. 2006;40(5):356-366.
  18. Echarri J.J. The development in footprint morphology in 1851 Congolese children from urban and rural areas, and the relationship between this and wearing shoes / J. J. Echarri, F. Forriol. Journal of pediatric orthopedics. Part B. 2003; 12(2):141-146.
  19. Ekcali O., Kosay C., Kaner B., Arslan Y., Sagol E., Soylev S., Iyidogan D., Cinar N., Peker O. Flexible flatfoot and related factors in primary school children: a report of ascreening study. Rheumatol Int. 2006; 26(11):1050-3.
  20. Evans A.M. The flat-footed child - to treat or not to treat: what is the clinician to do? / A. M. Evans. J Am Podiatr Med Assoc. 2008; 98(5):386-93.
  21. Forriol F. Footprint analysis between three and seventeen years of age / F. Forriol, J. Pascual. Foot & ankle. 1990; 11(2):101-104.
  22. Franklin J. Obesity and risk of low self-esteem: a statewide survey of Australian children/ J. Franklin [et al.]. Pediatrics. 2006; 118(6): 2481-2487.
  23. Garcia-Rodríguez A. Flexible flat feet in children: a real problem? / A. Garcia-Rodriguez [et al.]. Pediatrics. 1999; 103(6):84.
  24. Giannini S. Kinematic and isokinetic evaluation of patients with flat foot / S. Giannini [et al.]. Italian journal of orthopaedics and traumatology. 1992; 18(2): 241-251.
  25. Giladi M. The low arch, a protective factor in stress fractures: a prospective study of 295 military recruits / M. Giladi [et al.]. Orthop Rev.1985;14:82-84.
  26. Grady J.F., Kelly C. Endoscopic gastrocnemius recession for treating equinus in pediatric patients / J. F. Grady, C. Kelly. Clin Orthop Relat Res. 2010; 458(4): 1033-8.
  27. Gutiérrez P.R. Giannini prosthesis for flatfoot / P. R. Gutiérrez, M. H. Lara. Foot Ankle Int. 2005; 26(11): 918-26.
  28. Hamel J. Resection of talocalcaneal coalition in children and adolescents without and with osteotomy of the calcaneus. Oper Orthop Traumatol. 2009;21(2): 180-92.
  29. Harris R.I. Hypermobile flat-foot with short tendo achillis / R. I. Harris, T. Beath.The Journal of bone and joint surgery. American volume.1948; 30A(1):116-140.
  30. Hayashi B. Gastrocnemius recession: Effective remedy for recalcitrant foot pain / B. Hayashi [et al.] / http:// ww/aaas.org/news/bulletin/oct07/clinical4.asp
  31. Hefti F. Flatfoot / F. Hefti, R. Brunner. Der Orthopäde. 1999; 28(2):159-172.
  32. Hunt A.E. Mechanics and control of the flat versus normal foot during the stance phase of walking / A. E. Hunt, R. M. Smith. Clinical biomechanics (Bristol, Avon). 2004;199(4):391-397.
  33. Jerosch J. The stop screw technique-- a simple and reliable method in treating flexible flatfoot in children / J. Jerosch, J. Schunck, H. Abdel-Aziz. Foot Ankle Surg. 2009;15(4):174-8.
  34. Kanatli U., Gözil R., Besli K., Yetkin H., Bölükbasi S. / U. Kanatli [et al.]. The relationship between the hind-foot angle and the medial longitudinal arch of the foot. Foot Ankle Int. 2006;(27)8:623-7.
  35. Keenan M.A. Valgus deformities of the feet and characteristics of gait in patients who have rheumatoid arthritis / M. A. Keenan [et al.]. The Journal of bone and joint surgery. American volume. 1991; 73(2):237-247.
  36. Kernbach K.J., Blitz N.M. The presence of calcaneal fibular remodeling associated with middle facet talocalcaneal coalition: a retrospective CT review of 35 feet Investigations involving middle facet coalitions. Part II / K. J. Kernbach, N. M. Blitz. J Foot Ankle Surg. 2008;47(4):288-94.
  37. Kilmartin T.E. The significance of pes planus in juvenile hallux valgus / T. E. Kilmartin, W. A. Wallace. Foot & ankle.1992;13(2):53-56.
  38. Koning P.M. Subtalar arthroereisis for pediatric flexible pes planovalgus: fifteen years experience with the cone-shaped implant / P. M. Koning, P. J. Heesterbeek, E. J. de Visser. Am Podiatr Med Assoc. 2009;99(5): 447-53.
  39. Kulcu D.G. Immediate effects of silicone insoles on gait pattern in patients with flexible flatfoot / D. G. Kulcu [et al.]. Foot ankle international. American Orthopaedic Foot and Ankle Society and Swiss Foot and Ankle Society. 2007;28(10):1053-1056.
  40. Lee J.H. Clinical or radiologic measurements and 3-D gait analysis in children with pes planus / J. H. Lee [et al.]. Pediatr Int. 2009;51(2):201-5.
  41. Leung A.K. A cross-sectional study on the development of foot arch function of 2715 Chinese children /A. K. Leung [et al.]. Prosthet. Orthop. Int. 2005;29(3):241-53.
  42. Levy J.C. Incidence of foot and ankle injuries in West Point cadets with pes planus compared to the general cadet population/ J. C. Levy [et al.]. Foot & ankle international. American Orthopedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 2006;27(12):1060-1064.
  43. Lin C.-J.J. Correlating Factors and Clinical Significance of Flexible Flatfoot in Preschool Children / C.-J. J. Lin [et al.]. Journal Of Pediatric Orthopedics. 2001;21(3):378-382.
  44. McPoil T.G. Effect of using truncated versus total foot length to calculate the arch height ratio / T. G. McPoil [et al.]. Foot (Edinburgh, Scotland). 2008;18(4):220-227.
  45. Meary R. On the measurement of the angle between the talus and the first metatarsal. Symposium: Le Pied Creux Essential / R. Meary. Rev Chir Orthop. 1967;53(389).
  46. Meary R. Symposium sur le pied plant / R. Meary. Ann Orthop Ouest. 1969;1:55-71.
  47. Mei-Dan O. The medial longitudinal arch as a possible risk factor for ankle sprains: a prospective study in 83 female infantry recruits / O. Mei-Dan [et al.]. Foot & ankle international. American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 2005;26(2):180-183.
  48. Menz H.B. Alternative techniques for the clinical assessment of foot pronation / H. B. Menz. Journal of the American Podiatric Medical Associa-tion.1998;88(3):119-129.
  49. Michelson J.D. The injury risk associated with pes planus in children / J. D. Michelson [et al. Foot Ankle Int. 2002; 27(7):629-633.
  50. Molayem I. Complications following correction of the planovalgus foot in cerebral palsy by arthroereisis / I. Molayem [et al.]. Acta Orthop Belg. 2009;(75)3:374-9.
  51. Mosca V.C. Flexible flat foot and skew foot / V. C. Mosca. Instr. Cource. Lect.1996;45:347-354.
  52. Mosca V.S. Flexible flatfoot in children and adolescents / V. S. Mosca. Journal of children’s orthopaedics. 2010;4(2):107-21.
  53. Murley G.S. Effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running: a systematic review / G. S. Murley [et al.]. Gait & posture. 2009;29(2):172-187.
  54. Nachbauer W. Effects of arch height of the foot on ground reaction forces in running / W. Nachbauer, B. M. Nigg. Medicine and science in sports and exercise. 1992;24(11):1264-1269.
  55. Nawoczenski D.A. The effect of foot structure on the three-dimensional kinematic coupling behavior of the leg and rear foot / D. A. Nawoczenski [et al.]. Physical therapy. 1998;78(4):404-416.
  56. Norman A.-C. Influence of excess adiposity on exercise fitness and performance in overweight children and adolescents / A.-C. Norman [et al.]. Pediatrics. 2005;115(6):e690-696.
  57. Pellegrin de, M. Subtalar screw-arthroereisis for correction of flat foot in children. Orthopade. 2005;34(9): 941-53.
  58. Pfeiffer M. Prevalence of flat foot in preschool-aged children / M. Pfeiffer [et al.]. Pediatrics. 2006; 118(2):634-639.
  59. Rao U.B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children / U. B. Rao, B. Joseph. J. Bone Joint Surg Br. 1992;74(4):525-527.
  60. Redmond A.C. Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index / A. C. Redmond [et al.]. Clinical biomechanics (Bristol, Avon). 2006;21(1):89-98.
  61. Redmond A.C. Normative values for the Foot Posture Index./ A.C. Redmond [et al.]. Journal of foot and ankle research. 2008;1(1):6.
  62. Rose G.K. The diagnosis of flat foot in the child / G.K. Rose [et al.]. The Journal of bone and joint surgery. British volume. 1985; 67(1):71-78.
  63. Rose Ch.R.E. Flat feet in children: When should they be treated? / Ch. R. E. Rose. Int. J. Orthop. Surg. 2007;6(1):1-10.
  64. Sachithanandam V. The influence of footwear on the prevalence of flat foot. A survey of 1846 skeletally mature persons / V. Sachithanandam, B. Joseph. The Journal of bone and joint surgery. British volume. 1995;77(2):254-257.
  65. Saltzman C.L. Measurement of the medial longitudinal arch / C. L. Saltzman [et al.] // Archives of physical medicine and rehabilitation. 1995;76(1):45-49.
  66. Scott G. Age-related differences in foot structure and function / G. Scott [et al.]. Gait & posture. 2007; 26(1):68-75.
  67. Shuen V. Acquired unilateral pes planus in a child caused by a ruptured plantar calcaneonavicular (spring) ligament. / V. Shuen, H.J. Prem. Pediatr Orthop B. 2009; 18(3):129-30.
  68. Smith M. A. Flat feet in children / M. A. Smith. BMJ (Clinical research ed.). 1990;301(6758):942-943.
  69. Soomekh D.J. Pediatric and adult flatfoot reconstruction: subtalar arthroereisis versus realignment osteotomy. surgical options / D. J. Soomekh, B. Baravarian. Clin Podiatr Med Surg. 2006;23(4):695-708.
  70. Sobel E. Natural history of the rearfoot angle: preliminary values in 150 children / E. Sobel [et al.]. Foot & ankle international. American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 1999;20(2):119-125.
  71. Staheli L. Corrective shoes for children: a survey of current practice / L. Staheli. Pediatrics. 1980;65:13-17.
  72. Staheli L.T. Planovalgus foot deformity. Current status / L.T. Staheli. Journal of the American Podiatric Medical Association. 1999; 89(2)94-99.
  73. Sullivan J.A. Pediatric flatfoot: Evaluation and management / J. A. Sullivan. J Am Acad Orthop Surg. 1999;7(1):44-53.
  74. Szczygiel E. Comparative analysis of distribution on the sole surface of arched feet and flat feet / E. Szczygiel [et al.]. Przeg. Lek. 2008;65(1): P. 4-7.
  75. Taunton J.E. A prospective study of running injuries: the Vancouver Sun Run “In Training” clinics / J. E. Taunton [et al.]. British journal of sports medicine. 2003;37(3):239-44.
  76. Tachdjian’s Pediatric Orthopaedics from the Texas Scottish Rite Hospital for Children. [ed. by J. A. Herring. 4-th ed.]. 2008.
  77. Templin D. The incorporation of allogeneic and autogenous bone graft in healing of lateral column lengthening of the calcaneus / D. Templin, K. Jones, D. S. Weiner. J Foot Ankle Surg. 2008;47(4):283-7.
  78. Thomas J.L. Radiographic values of the adult foot in a standardized population / J. L. Thomas [et al.]. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 2006;45(1):3-12.
  79. Trzcinska D. Health school readiness of overweight and obese children against a background of peers / D. Trzcinska [et al.]. Pediatr Endocrinol Diabetes Metab. 2008;14(3):193-8.
  80. Vittore D.A. Extensor deficiency: first cause of childhood flexible flat foot / D. A.Vittore [et al.]. Orthopedics. 2009;32(1):28-35.
  81. Tudor A. Flat-footedness is not a disadvantage for athletic performance in children aged 11 to 15 years / A.Tudor [et al.]. lana.ruzic@kif.hr., PMID: 19254974 [PubMed - indexed for MEDLINE].
  82. Villarroya M.A. Assessment of the medial longitudinal arch in children and adolescents with obesity: footprints and radiographic study / M. A. Villarroya [et al.]. Eur J Pediatr. 2009; 168(5):559-67.
  83. Volpon J.B. Footprint analysis during the growth period / J. B. Volpon. Journal of pediatric orthope-dics.1994; 14(1):83-85.
  84. Vukasinovic Z. Flat feet in children /Z. Vukasinovic’ [et al.]. Srp Arh Celok Lek. 2009;137(5-6):320-2.
  85. Walczak M. Flexible flatfoot in children-a controversial subject / M. Walczak, M. Napiontek. Chirurgia Narzadow Ruchu I Ortopedia Polska. 2003; 68(4):261-267.
  86. Wan S.C. Metatarsus adductus and skewfoot deformity / S. C. Wan. Clin Podiatr Med Surg. 2006;23(1):23-40.
  87. Wearing S.C. The arch index: a measure of flat or fat feet? / S. C. Wearing [et al.]. Foot & ankle international. American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 2004; 25(8):575-581.
  88. Wenger D.R. Corrective Flexible Shoes and Inserts Flatfoot in Infants as Treatment for and Children/ D. R. Wenger [et al.]. The Journal of bone and joint surgery. 1989;71(6):800-810.
  89. Wrotniak B.H. The relationship between motor proficiency and physical activity in children / B. H. Wrotniak [et al.]. Pediatrics. 2006; 118(6):e1758-1765.



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