In flexible flatfeet in children the transition from physiological to pathological is obscure. This is seldom the case in pediatric foot deformities and makes assessment of the therapy required all the more difficult. On the other hand, the results of follow-up examinations of treated and non-treated cases of flexible flatfeet suggest that the value of arch-support insoles, which used to be prescribed widely, is more than questionable. In addition to the usual age-related fall of the medial arch and the physiologically accentuated valgus position of the calcaneous in children of preschool age, free movement of the joints of the foot should be taken into consideration in examinations, and attention should be paid to active correction of flexible flatfeet, in the tiptoe position. On the basis of our present knowledge, therapy only appears to be necessary for severe flexible flatfeet, i.e., when the heel valgus is over 20 degrees and, at the same time, there is complete lack of a medial arch. When weight is placed on the insole, the lack of medial arch can be seem to be completely or even convexly twisted. In cases of severe flexible flatfeet, further diagnostic clarification is usually necessary, in particular roentgenological examinations in order to exclude the possibility of other foot deformities by means of differential diagnosis.
在儿童柔性扁平足中，从生理性到病理性的转变并不明显。这种情况在小儿足部畸形中很少见，这使得评估所需的治疗更加困难。另一方面，对柔性扁平足治疗和未治疗病例的随访检查结果表明，过去广泛使用的足弓支撑鞋垫的价值很值得怀疑。除了通常与年龄相关的内侧足弓下降以及学龄前儿童跟骨生理性加重的外翻位置外，在检查中还应考虑足部关节的自由活动，并应注意在踮脚尖位置对柔性扁平足进行主动矫正。根据我们目前的知识，似乎只有严重的柔性扁平足才需要治疗，即足跟外翻超过20度且同时完全没有内侧足弓时。当体重压在鞋垫上时，可以看到内侧足弓完全缺失甚至呈凸形扭转。在严重柔性扁平足的情况下，通常需要进一步的诊断性检查，特别是进行X线检查，以便通过鉴别诊断排除其他足部畸形的可能性。
