Flatfoot, also known as pes planus, is a deformity of the foot characterized by a decrease or absence of the medial longitudinal arch, which may lead to postural and locomotion abnormalities.

Peroneal spastic flatfoot (PSFF) involves peroneal spasm and subtalar restriction, yet optimal conservative care is undefined. This pilot retrospective study explored the preliminary outcomes of botulinum toxin type A (BoNT-A) injection combined with rehabilitation in 19 PSFF patients (10 with structural abnormalities [SA], 9 without [NSA]). Pain (VAS), spasticity (MAS), and function (AOFAS-AH) were assessed at baseline, 1, 3, and 6 months. Significant improvements were observed across all metrics (P < 0.05). The median VAS decreased from 4 to 0, median AOFAS-AH improved from 67 to 100, and median MAS reduced from grade 4 to grade 0 at 6 months relative to baseline. In subgroup comparisons, NSA patients achieved superior outcomes, with significantly higher AOFAS-AH and lower MAS at 3 and 6 months (P < 0.05) and 100% satisfaction versus 40% in SA patients (P < 0.05). One patient experienced transient calf swelling. These exploratory findings suggest BoNT-A combined with rehabilitation may warrant further investigation as a potential conservative option for PSFF, particularly among patients without structural abnormalities. Due to the small sample size and lack of control group, these results should be interpreted as exploratory rather than confirmatory. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Paediatric flexible flatfoot is the most common orthopaedic deformity encountered in paediatric practice. Although most cases are asymptomatic and resolve spontaneously, a subgroup of patients develops pain, functional impairment, and progressive deformity, requiring surgical treatment after failure of conservative management. Evans and Cotton osteotomies remain the standard procedures for correcting hindfoot valgus and restoring the medial longitudinal arch, both requiring a structural interposition material to maintain correction. Traditionally, autografts, allografts, and xenografts have been used; however, these options are associated with donor-site morbidity, graft resorption, disease transmission, and potential loss of correction over time. Porous titanium wedges have recently emerged as a synthetic alternative, offering immediate structural stability, osseointegration, and resistance to resorption while eliminating donor-site complications. This review evaluates the current evidence regarding surgical management of paediatric flexible flatfoot, comparing radiological outcomes, functional results, and complication profiles among available interposition materials, and discussing their role in contemporary reconstructive foot surgery.

Early childhood is a critical developmental period during which behavioral and anthropometric characteristics associated with child health begin to emerge. In recent years, screen exposure and sedentary behaviors have attracted increasing attention because of their potential associations with physical activity patterns, growth indicators, and musculoskeletal health outcomes in children. However, their relationships with foot arch categories during early childhood remain insufficiently explored. This analytical cross-sectional study aimed to examine the associations between screen exposure, body mass index (BMI) percentile, and foot arch categories in preschool children. The study included 509 children aged 5-6 years attending four public preschools in Çanakkale, Türkiye. Foot arch profile was assessed using a podoscope and classified according to the Staheli Arch Index and Jack test. Screen exposure was evaluated based on parent-reported daily duration categories, and BMI percentiles were calculated using World Health Organization reference standards. Multinomial logistic regression analysis was conducted to examine associations between screen exposure, BMI percentile, and foot arch categories after adjustment for age and sex. The findings indicated that both screen exposure and BMI percentile were significantly associated with specific foot arch categories. More consistent associations were observed particularly in the rigid flatfoot category, where higher screen exposure and higher BMI percentile were more frequently observed. However, the relatively small number of participants in the highest screen exposure category should be considered when interpreting these findings. Overall, the findings suggest that screen exposure and BMI percentile may be associated with specific foot arch categories during early childhood. Although causal interpretations cannot be made due to the cross-sectional design, the findings may contribute to the growing literature examining behavioral and anthropometric characteristics associated with musculoskeletal indicators in preschool children. Further longitudinal and intervention-based studies are needed to clarify the direction and underlying mechanisms of these associations.

Recent increases in life expectancy have been accompanied by a growing prevalence of foot deformities, leading to increased clinical interest in their diagnosis and treatment. However, conventional radiography and computed tomography (CT) have inherent limitations in accurately evaluating the complex three-dimensional (3D) morphology of foot deformities, including flatfoot deformity and cavovarus deformity. These limitations may hinder precise characterization of deformity patterns and complicate surgical decision making. To address these challenges, substantial efforts have recently been directed toward the development of advanced imaging and analytic techniques. Weightbearing computed tomography (WBCT) combined with a semiautomated segmentation technique has emerged as a promising modality for the 3D assessment of normal foot anatomy and pathologic deformities. Recent studies have demonstrated the clinical utility of these technologies in improving deformity characterization, quantitative morphologic analysis, and preoperative planning. This review summarizes the current literature regarding 3D morphologic analysis of foot deformities using WBCT and semiautomated segmentation software, provides a comprehensive overview of contemporary imaging-based analytic techniques, and discusses their potential clinical applications and future directions in foot and ankle surgery.

Background and Objectives: In degenerative spine disease, compensatory mechanisms are activated to maintain upright posture, extending beyond the spine to involve the pelvis, lower limbs, and feet. These adaptations may be accompanied by differences in foot alignment, which could be associated with sagittal balance. The aim of this study is to investigate the relationship between foot alignment and spinal posture in patients with degenerative spine disease and evaluate whether foot deformities are associated with sagittal imbalance in degenerative spine disease. Materials and Methods: We retrospectively reviewed 98 patients with degenerative spine disease who underwent preoperative standing EOS imaging between 2017 and 2025 at a single academic spine centre. Meary's angle, talocalcaneal angle, and calcaneal pitch were measured on lateral EOS images to classify feet as flat, normal, or cavus. Spinopelvic parameters were extracted from EOS and conventional radiographs. Differences in spinal parameters across foot groups were compared using ANOVA, and linear regression evaluated associations between sagittal vertical axis (SVA) and foot angles. Results: Among spinopelvic parameters, only SVA significantly differed between foot groups, with flatfoot patients showing greater forward imbalance (p = 0.035). Regression analysis demonstrated an inverse relationship between SVA and both talocalcaneal angle (p = 0.003) and calcaneal pitch (p = 0.034), suggesting that greater forward trunk inclination was associated with flatter feet. Degenerative scoliosis patients demonstrated a bimodal pattern with more flat and cavus feet (p = 0.006), while herniated disc patients more often exhibited flatfoot (p = 0.031). Conclusions: Foot posture abnormalities, particularly flatfoot, are associated with sagittal spinal imbalance, suggesting foot posture may be associated with global alignment and could reflect distal postural adaptations.

Background: Pes planus is a common foot deformity that may lead to both structural and functional consequences. This alteration in foot morphology has been associated with changes in neurosensory mechanisms such as proprioception and balance. This study aims to evaluate proprioception and balance parameters in young adults with pes planus by comparing them with healthy individuals. Methods: This case-control study, which had a quantitative and cross-sectional design, included a total of 90 volunteer university students aged 18-30. The presence of pes planus was assessed using the Navicular Drop Test. Proprioception assessment was performed using a digital goniometer to measure active and passive joint position sense, while balance assessment was performed using the Y Balance Test. Results: The groups were similar in terms of demographic and anthropometric characteristics (p > 0.05). In the proprioception assessment, a significant difference was observed in active joint position sense scores in individuals with pes planus (p = 0.032). In contrast, no significant difference was found between the two groups in terms of passive joint position sense (p = 0.769). According to the Y Balance Test results, no difference was observed in the anterior and posteromedial directions (p = 0.690 and p = 0.806). At the same time, the balance performance of individuals with pes planus was significantly lower in the posterolateral direction (p = 0.045). Conclusions: Young individuals with flexible pes planus showed differences in active joint position sense and balance performance in the posterolateral direction. This situation shows that pes planus may be associated with not only structural but also neurosensory functions. The findings highlight the importance of planning protective interventions early. In the future, there is a need for longitudinal studies conducted with larger and more heterogeneous samples, including rigid type pes planus.

Lateral column lengthening (LCL) calcaneal osteotomy is a well-established surgical procedure used in flexible flatfoot reconstructive surgery. The effects of LCL on subtalar joint (STJ) range of motion (ROM) have not been thoroughly explored in the literature. Our study aimed to objectively measure the average decrease in the total ROM of the STJ following LCL. A retrospective cohort study was conducted on 15 patients (20 feet) who underwent LCL for various indications. Data for STJ ROM was collected from both the preoperative and postoperative periods. Mean follow-up for the cohort was 12 weeks postoperatively. The mean total preoperative STJ ROM was 39.65 ± 2.52 degrees, while the mean total postoperative STJ ROM was 19.17 ± 2.62 degrees (p < 0.001). This represents a statistically significant reduction of 20.48 degrees (48% decrease) in STJ ROM from preoperative to postoperative measurements. This study provides the first objective measurement of the STJ ROM decrease following LCL calcaneal osteotomy on patients in vivo. The findings highlight the substantial impact of the procedure on the ROM in the STJ. These results have important implications for patient management and should be considered when evaluating the outcomes of LCL procedures. Further research is warranted to explore the functional consequences and long-term effects of the reduced STJ ROM and to develop strategies for optimizing foot function in patients undergoing this procedure.

Minimally invasive procedures for pes planovalgus offer a safe alternative to open surgery and reduce postoperative morbidity significantly. The significantly lower risk of wound-healing complications and the markedly reduced need for analgesics are among the factors that favor minimally invasive techniques. Owing to the substantially lower complication rate while maintaining a high correction potential, percutaneous calcaneal displacement osteotomy can now be regarded as the gold standard. Depending on the individual pathophysiology, additional procedures are usually required in adult acquired flatfoot, which can also be performed using minimally invasive techniques. Besides the overview of percutaneous calcaneal osteotomy, this article also provides an overview of endoscopic FDL transfer and the percutaneous reverse Cotton osteotomy, surgical techniques that are frequently combined in the treatment of flexible flatfoot deformity.