👣 Section 715.5 · Hypermobile Pes Planus (Flexible Flatfeet)

Nelson Textbook of Pediatrics 22nd Edition | Flexible flatfoot is a common physiologic variant in children. Arch appears with toe-standing. Most children are asymptomatic. Treatment only for pain: arch supports, heel cord stretching if tight. No surgery for asymptomatic flatfoot. Associated with ligamentous laxity, Down syndrome, Ehlers-Danlos.

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📋 30 Clinical Scenarios — Flexible Flatfoot (Pes Planus)

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🩺 Clinical Recognition: Flexible Flatfoot

Select a presentation to review diagnostic clues and management per Nelson 715.5.

📋 Stepwise Management of Flexible Flatfoot

🔑 Key Principles — Nelson Section 715.5
• Definition: Loss of medial longitudinal arch with weight-bearing; arch reconstitutes with toe-standing or non-weight-bearing.
• Physiologic: Flatfoot is normal in neonates and toddlers. Arch develops between 5-10 years in vast majority.
• Asymptomatic: No treatment needed. Reassure parents.
• Symptomatic (pain, fatigue): Arch supports (nonprescription or custom UCBL orthosis).
• Tendo-Achilles contracture: Must correct with stretching before using arch supports.
• Rigid flatfoot: Differentiate from tarsal coalition, JIA. Requires further evaluation.
• Surgery: Lateral column lengthening (calcaneal osteotomy) only for persistent pain after failed conservative care.

    ⚡ Reflex Prompts — Clinical Decisions in Flatfoot

    📖 Summary: Hypermobile Pes Planus (Flexible Flatfeet) — Nelson 715.5