Clinical management of flatfoot syndrome in children and adolescents Many parents and most orthopedic surgeons are unaware of and unfamiliar with flatfoot syndrome in children and adolescents. First of all, it is important to be clear about a few concepts: flatfoot is called flatfoot syndrome if it produces pain and decreased motor ability. Most flat feet that occur in preschoolers after standing and bearing weight are physiologically flat feet. Normal arches form around 6-7 years of age, and if the foot remains flat after this time, most do not recover spontaneously, and some patients will gradually worsen and develop flatfoot syndrome, which may require surgical intervention. Physiologically flat feet basically require conservative treatment, and arch pads placed in shoes are a good option, and if the heel bone is significantly exostotic, an AFO (ankle foot support with articulation) is preferable. after the age of 7 years, if the foot is flat, it is still mostly a flexible flat foot. In the authors’ experience generally some patients between the ages of 10 and 14 will develop symptoms, i.e. flatfoot syndrome. Surgical intervention is required. Current surgical interventions for symptomatic tender flatfoot include: heel osteotomy (heel lengthening); and subtalar joint braking. In children and adolescents with flatfoot, there is a distinct pathological change of excessive movement of the talus over the heel bone during weight bearing or known as subluxation. Hyprocure brake bolt implantation technique was introduced in China in 2012 and has been performed in Beijing and Shenyang (Shengjing Hospital) for the treatment of children and adolescents with flatfoot syndrome. The incision is very small (2cm) and resumes work and school quickly. It is welcomed by the majority of patients. In case of combined pathological changes such as Achilles tendon contracture and paronychia, it needs to be solved together with surgery. Heel lengthening requires osteotomy of the heel bone and is weight-free for 2-3 months after surgery. For rigid flatfoot, most of them require osteotomy and soft tissue surgery, and the long-term outcome is poor. Therefore, families and orthopedic surgeons should pay attention to early flexible flatfoot in children and adolescents and give bracing or surgical intervention to prevent continuous progression.