American College of Foot and Ankle Surgeons (Podiatrists) Clinic Guidelines: Diagnosis and Treatment of Paediatric Flat Foot

ow-arched or “flat” feet are usually normal variants of foot posture and require no interference. Some feet simply have a low arch, but have neutral rotational and coronal plane alignment. Others are “flat” because the hindfoot and forefoot are rotated with respect to one another more than is usual. The subtalar joint is more pronated than usual, so the hindfoot is in valgus and the Achilles tendon may be tight. The forefoot is abducted and supinated at the midtarsal joint, so that the neck of the talus, which is normally in line with the first metatarsal in both transverse and sagittal planes, comes to point below and medial to the first ray. Because the hindfoot pronation and forefoot supination are balanced in most people, the foot sits plantigrade but the head of the talus in the medial border of the foot is low and the foot appears flat. This is the “overpronated” or “planovalgus” foot – but it must be emphasised again that such feet are usually asymptomatic, and there is no evidence that they are at a predictably high risk of future symptoms if not “treated”.
"The most important team member is the one who can restrain more therapeutically aggressive colleagues from interfering with normal feet!"

Medscape Report on presentation by Vincent S. Mosca, MD 2002
Conditions such as flatfoot and clubfoot were highlighted, showing new advances in research as well as surgical and nonsurgical management of each.