In a child with symptomatic flexible flatfoot (pes planovalgus), the initial conservative management includes arch support orthotics. When surgical intervention becomes necessary in a skeletally immature patient, the preferred procedure is:

• A Triple arthrodesis of subtalar, talonavicular, and calcaneocuboid joints
• B Calcaneal lengthening osteotomy (Evans procedure) or subtalar extra-articular screw arthroereisis ✓
• C Tibialis posterior tendon transfer to the dorsum
• D Plantar fascia release

Explanation

In a skeletally immature child, joint-preserving procedures are preferred. Calcaneal lengthening osteotomy (Evans osteotomy) through the anterior calcaneus corrects valgus hindfoot deformity and abduction while preserving joint motion. Subtalar extra-articular arthroereisis (screw/implant blocking subtalar eversion) is a minimally invasive alternative popular in children because it is reversible. Triple arthrodesis is reserved for rigid, symptomatic flatfoot in the skeletally mature patient or after failed joint-sparing surgery, as it permanently abolishes hindfoot motion and leads to adjacent joint degeneration. Tibialis posterior transfer addresses tendon dysfunction, not primary flexible flatfoot.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.