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AIMS: There is increasing evidence that flexible flatfoot (FF) can lead to symptoms and impairment in health-related quality of life. As such we undertook an observational study investigating the aetiology of this condition, to help inform management. The hypothesis was that as well as increased body mass index (BMI) and increased flexibility of the lower limb, an absent anterior subtalar articulation would be associated with a flatter foot posture. PATIENTS AND METHODS: A total of 84 children aged between eight and 15 years old were prospectively recruited. The BMI for each child was calculated, flexibility was assessed using the lower limb assessment scale (LLAS) and foot posture was quantified using the arch height index (AHI). Each child underwent a sagittal T1-weighted MRI scan of at least one foot. RESULTS: An absent anterior subtalar articulation (p < 0.001) and increased LLAS (p = 0.001) predicted a low AHI. BMI was not a significant predictive factor (p = 0.566). CONCLUSION: This is the first study to demonstrate the importance of the morphology of the subtalar joint on the underlying foot posture in vivo. TAKE HOME MESSAGE: Flexibility of the lower limb and absence of the anterior facet of the subtalar joint are associated with flexible FF and may influence management of this common condition.

Original publication




Journal article


Bone joint j

Publication Date





564 - 568


Pes planovalgus; Subtalar joint; Flat feet; Joint hypermobility, Adolescent, Arthrodesis, Child, Female, Flatfoot, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Posture, Prospective Studies, Quality of Life, Range of Motion, Articular, Subtalar Joint