Idiopathic flexible flatfoot in the adolescent.

In summary, factors to consider in treatment are (1) the patient's age; (2) the flexibility of the condition; (3) the severity of deformity; (4) the presence of equinus; (5) abnormal shoe wear; and (6) the symptoms. When a child presents with severe flexible flatfoot one should rule out an underlying neuromuscular disorder and perform a complete biomechanical evaluation to ascertain any rotational or angular conditions of the legs that might influence the treatment. If a child is in group 1 (ages 4 to 7), a Helfet heel seat with a medial plantar wedge is usually adequate treatment. In the group II (ages 8 to 12) adolescent with flexible flatfoot, more control of the calcaneal eversion is needed. This is obtained by using a device constructed from a plaster mold taken while the foot is in neutral position. This UCBL type of device must usually extend to the metatarsal heads and be elevated on the medial and lateral sides. The group III (ages 13 to 17) adolescent usually has the additional problem of a forefoot varus, which must be controlled using a forefoot post. It is also not unusual to have to add additional wedging inside the heel of the shoe to invert the heel.