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.

Background: Hindfoot arthrodesis is commonly used to treat rigid flatfoot. While traditionally performed as a triple arthrodesis, recent evidence supports medial double arthrodesis, involving only the talonavicular and talocalcaneal joints and sparing the calcaneocuboid (CC) joint. This study aims to evaluate the long-term condition of the spared CC joint more than 10 years after double arthrodesis. Methods: We retrospectively reviewed 17 feet in 13 patients (8 women, 5 men; mean age 43.8 ± 16.5 years) who underwent double arthrodesis for rigid flatfoot. Clinical outcomes were assessed using the AOFAS score and a visual analog pain scale. Radiographic evaluation of the CC joint was based on Graves' four-stage classification, preoperatively and at final follow-up (minimum 10 years). Results: The mean follow-up was 154.6 ± 20.4 months. No patient required additional CC arthrodesis, and all CC joints remained asymptomatic. Radiographically, degeneration improved in 9 cases, was stable in 6, and worsened in 2. The mean AOFAS score significantly improved from 23.7 ± 9.3 preoperatively to 70.1 ± 9.3 at the longest follow-up (p < 0.0001). Similarly, the mean VAS pain score decreased from 6.4 ± 1.3 preoperatively to 2.1 ± 1.2 at follow-up (p < 0.0001). Conclusions: Double medial arthrodesis spares the CC joint, enabling arthrodiastasis and subchondral remodeling over time. This contributes to long-term pain relief and improved radiographic outcomes. Preserving minimal motion at the CC joint may enhance foot adaptability to uneven terrain and reduce the need for further surgical intervention.

Progressive collapsing foot deformity (PCFD) is an acquired condition characterised by collapse of the medial longitudinal arch, hindfoot valgus and forefoot abduction. This condition predominantly affects middle-aged and older patients and can lead to significant pain and functional impairment. Clinical assessment is key to identifying a flexible versus rigid foot deformity. The Johnson and Strom classification provides a framework for staging the disease process and guides management. Treatment can involve non-operative measures such as orthoses, or operative measures tailored to the components of deformity present. An understanding of the pathophysiology and biomechanical drivers is key to individualising treatment. Recent advances include a better understanding of peritalar subluxation as a causative factor, and a focus on motion-preserving surgical techniques.

The primary objective of the minimally invasive Cotton osteotomy is to correct sagittal malalignment of the medial column by targeted plantarflexion, thereby restoring alignment and contributing to the reconstruction of complex pes planovalgus deformities within a joint-preserving surgical approach.

(1) Background: Gait analysis technologies have advanced; however, traditional systems like optical motion capture are lab-bound and costly, limiting rehabilitation monitoring. This cross-sectional study evaluates self-powered triboelectric nanogenerator (TENG) insoles combined with IMU sensors to assess gait asymmetry, plantar pressure signatures, age effects and injury history in rehabilitation patients, aiming to enable portable, battery-free phenotyping. (2) Methods: Fifty-three patients (22 females, 31 males; age, 29 ± 26 years) from Astana clinics with trauma histories (e.g., spine, ankle, fractures) and 10 healthy references underwent a 2 min walk test (2MWT). TENG insoles captured plantar loading; ankle/knee IMUs measured spatiotemporal parameters (cadence, asymmetry). The data were normalized; the analyses used an ANOVA and correlations (Python 3.14.3). (3) Results: The TENG sensors showed force/frequency linearity (up to 10 V at 20 N). The cadence averaged 101 ± 10 steps/min, declining with age (r = -0.31, p = 0.03) and fractures (r = -0.23, p = 0.04). The asymmetry varied (-54% to +31%) without category differences. Flatfoot (55%) was linked to lateral loading shifts; condition-specific waveform signatures emerged (e.g., lateral heel in ankle issues). (4) TENG-IMU systems feasibly capture gait phenotypes in heterogeneous cohorts, supporting out-of-lab monitoring for personalized rehabilitation without batteries. Prospective validation is required for further practical implications.

Background/Objectives: Subtalar arthroereisis (STA) is widely used for symptomatic pediatric flexible flatfoot and provides consistent radiographic correction. However, return to sport (RTS) after STA is less well defined, and the relative role of early postoperative pain versus radiographic correction remains unclear. Methods: We performed a retrospective observational cohort study of consecutive skeletally immature patients treated with STA using a non-absorbable endosinotarsal screw at a single tertiary center. Inclusion criteria were symptomatic flexible flatfoot refractory to >6 months of conservative treatment, complete pre-/postoperative weight-bearing radiographs, complete functional data, and minimum follow-up of 6 months. The primary endpoint was RTS to the pre-symptom primary sport at final follow-up. Secondary outcomes were UCLA Activity Score, FAAM Sport subscale, and postoperative VAS. Radiographic correction was quantified as delta change (Δ) in Meary, Costa-Bertani, and Kite angles. Group comparisons used nonparametric tests. A parsimonious multivariable logistic regression model (EPV-constrained) included UCLA at 3 months, VAS pain, and ΔMeary. Results: Fifty patients were included (mean follow-up 9.2 ± 2.5 months; range 6-14); 27/50 (54%) resumed their primary sport. Baseline characteristics were comparable between Returners and Non-Returners. Returners showed higher early postoperative UCLA scores than Non-Returners (8.0 [7.0-8.5] vs. 6.0 [5.0-7.0], p = 0.005). FAAM Sport and VAS pain did not differ significantly between groups (p = 0.224 and p = 0.493, respectively). Radiographic correction magnitude was similar between groups (ΔMeary p = 0.938; ΔCosta-Bertani p = 0.984; ΔKite p = 0.108). In multivariable analysis, UCLA at 3 months was the only independent correlate of RTS (OR 2.65 per point, 95% CI 1.34-6.15; p = 0.009), whereas VAS pain (OR 0.98, 95% CI 0.76-1.25; p = 0.892) and ΔMeary (OR 1.01, 95% CI 0.91-1.13; p = 0.875) were not significant. Conclusions: In this cohort, STA achieved substantial radiographic correction, but neither correction magnitude nor early postoperative pain independently correlated with RTS at short-term follow-up. Early postoperative activity level was the strongest independent correlate of sport resumption, supporting a function-centered postoperative assessment beyond radiographic alignment alone.