Paediatric Flatfeet - a 2020 guide for clinicians to identify the 'Boomerangs'

The paediatric flatfoot has long occupied a place in the medical literature, with concerns about the significance of its appearance. At the end of the first decade of the 21st century, a paper in this journal provoked active debate about the paediatric flatfoot as part of development, and proposed a considered titration of presenting cases in effort to justify treatment and appreciated the range and expected change in normal foot posture with growth. A decade later, the availability of normative paediatric foot posture data, and the prospective findings to confirm lessening flatfeet with age, encourage a structured and considered approach to this frequent primary care presentation. The pragmatic concept of the boomerang is built upon the research identifying the paediatric flatfeet likely to be symptomatic, thus requiring intervention, and filtering from those likely to remain asymptomatic. Differential diagnoses are advisedly considered, and gait remains the hallmark outcome. In this contemporary guide, an eight step strategy has been developed to improve the approach to community paediatric flatfeet concerns. Further, the three 'boomerang' flatfeet factors delineating symptomatic from asymptomatic flatfeet, and applicable cut-off levels, are availed for practical reference and use. Given the recognised state of overdiagnoses and resulting unnecessary treatment that pervades the 21st century, it is timely for clear '20:20' vision for the presentation of the paediatric flatfoot.