How to approach the pediatric flatfoot

Figure 1 Weightbearing alignment of the foot: Note the left midfoot abduction (A); note the left foot heel valgus and the “too many toes” sign (B).

Figure 2 Weightbearing lateral view X-ray of the left foot prior (A) and post (B) subtalar arthroereisis. Note correction of Meary’s angle as well as correction of the hindfoot valgus.

Figure 3 Postoperative weightbearing anteroposterior (A), lateral (B), and hindfoot (C) views of the left foot in a patient with a painful accessory navicular syndrome treated with a medializing calcaneal osteotomy and fusion of the accessory navicular with a screw. Note correction of the talonavicular uncoverage (A), Meary’s line (B), and hindfoot valgus (C).

Figure 4 Preoperative anteroposterior (A) and lateral (B) views weightbearing X-rays in a child with a flexible flatfoot; on the anteroposterior view, note about 50% of talonavicular uncoverage; postoperative anteroposterior (C) and lateral (D) weightbearing views following a lateral column lengthening and cotton osteotomy. Note the excellent correction of the talonavicular uncoverage (C) and Meary’s angle (D).