No, although they frequently coexist. Valgus foot refers to alignment: the heel is inverted. Flatfoot refers to the arch: the internal longitudinal arch is collapsed. The vast majority of flatfeet are also valgus and vice versa, forming the so-called flatfoot-valgus or pronator foot. But there are flatfeet with preserved arch (typically in children) and flatfeet with discrete valgus. Distinguishing between them is important because the emphasis of treatment varies.

Up to the age of 4-6 years, a certain degree of valgus is physiological. After that age, if the valgus persists (more than 7-10° clinical), if it is asymmetrical between the two feet, if it is accompanied by pain or fatigue when walking, or if it limits the child’s activity, a podiatric evaluation is recommended. Most asymptomatic pediatric valgus correct themselves with growth. Pediatric surgery is rare.

The valgus foot decompensates the ascending kinetic chain. Excessive pronation of the rearfoot drags the tibia in internal rotation, the patella in lateral overload and the hip in adduction, generating anterior knee pain, patellar tendinopathy, overload of the posterior tibialis and Achilles, pain in the external aspect of the hip and low lumbar overload. In the foot, it favors bunions, claw toes and plantar fasciitis.

In adults, persistent or de novo valgus foot is usually associated with posterior tibial tendon dysfunction and is staged as adult acquired flatfoot (Johnson-Strom). Treatment is stage-dependent: insoles and rehabilitation in stage I, Arizona-type orthoses or MIS arthroereisis in stage II flexible, and regimented reconstruction in advanced stages.

They control it functionally, not correct it anatomically. A well-designed insole, with a medial calcaneal post and supinator wedge adjusted to the degree of valgus, returns the calcaneus to neutral alignment during gait, reduces posterior tibial overload and normalizes the kinetic chain. It is the first line of treatment and resolves or stabilizes most symptomatic conditions.

It is a minimally invasive technique in which a small implant is inserted into the sinus of the tarsus through a percutaneous incision of a few millimeters. The implant acts as a mechanical stop that limits excessive pronation, correcting the valgus and restoring the arch. It is performed under local or regional anesthesia, on an outpatient basis. It is a reasonable alternative in flexible valgus feet refractory to conservative treatment.

No. Arthroereisis is percutaneous, minimally invasive, reversible and is indicated in flexible valgus feet. Medializing calcaneal osteotomy is a more complex, definitive open surgery, with a longer immobilization period, and is reserved for rigid cases, important valgus or advanced stages of adult acquired flatfoot. The decision depends on age, grade, stiffness and associated pathology.

Immediate bipedestation with walker boot or post-surgical shoe from the same day. Reintroduction of normal footwear with insole at 2-3 weeks, light activity at 4-6 weeks and impact sports at 10-14 weeks, with intermediate clinical review. The millimetric scar is practically imperceptible after a few months.

Not at entry. In the vast majority of cases, pediatric valgus is resolved with observation, appropriate footwear and, if there is symptomatology, insoles. Pediatric valgus surgery is exceptional and is only considered when there is persistent pain or functional limitation after months of conservative treatment, generally from 9-12 years of age. A reasonable first step is podiatric assessment.

Without treatment, adult valgus foot tends to progress slowly over time, especially in patients with overweight, hypertension or established tibialis posterior dysfunction. That is why clinical discharge always includes a maintenance plan: customized insole, strengthening program and annual check-up. After well-indicated arthroereisis, recurrence of the original condition is rare.