Pediatric Flatfoot: Is There a Need for Surgical Referral?

Pediatric foot deformities are a common finding, concerning up to 44% of preschool aged children. The absence of accepted international guidelines, as well as heterogeneity in definitions and measurements, makes management of pediatric flatfoot a challenge, and decisions surrounding specialized care referral confusing and biased. The objective of this narrative review is to provide guidance to primary care physicians treating these patients. A non-systematic review of the literature regarding the development, etiology, and clinical and radiographic assessment of flatfeet using the PubMed and Cochrane Library databases was performed. The exclusion criteria for the review were adult populations, papers detailing the outcome of a specific surgical procedure, and publications prior to 2001. The included articles showed great heterogeneity in definition and proposed management, which makes the study of pediatric flatfoot challenging. Flatfoot is a common finding in children under 10 years old, and should not be considered pathological unless stiffness or functional limitation are present. Surgical referral should be reserved to children with stiff or painful flatfoot, while simple observation is indicated for flexible, asymptomatic flatfeet.

Automated summary

Pediatric foot deformities are common, affecting up to 44% of preschool aged children. There is a lack of international guidelines and uniform definitions and measurements, which complicates the management of pediatric flatfoot and the decision-making process for specialized care referral. This narrative review aims to provide guidance to primary care physicians treating these patients. The articles reviewed showed significant heterogeneity in definition and proposed management of pediatric flatfoot, making it a challenging condition to study. Flatfoot is a common finding in children under 10 years old, but should only be considered pathological if accompanied by stiffness or functional limitation. Surgical referral is appropriate for children with stiff or painful flatfoot, while observation is recommended for flexible, asymptomatic flatfeet.