A 4-year-old boy is brought by his parents because both feet look flat. He is asymptomatic, walks and runs normally, and the arch reappears when he stands on tiptoe and when the feet hang over the edge of the examination table. There is no hindfoot stiffness. The most appropriate management is:

• A Prescription of moulded arch support insoles
• B Tibialis posterior strengthening exercises
• C Calcaneal lengthening osteotomy
• D Reassurance with no active treatment ✓

Explanation

Flexible flatfoot in an asymptomatic young child is a normal variant. The arch develops progressively through childhood and flexibility, demonstrated by arch restoration on tiptoeing, distinguishes it from pathological rigid flatfoot. No treatment, including orthotics, alters the natural history, and Indian exam convention follows this teaching that asymptomatic flexible flatfoot requires only parental reassurance. Surgery such as calcaneal lengthening is reserved for symptomatic rigid or severe deformity, and tibialis posterior training addresses adult-acquired dysfunction.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.