The essential or “weak” flatfoot, under 6 years, is always asymptomatic. Between 6 and 13
years, a few cases may become symptomatic and require treatment. In adult age, the asymptomatic
flatfoot should be considered a physiological variant and in most cases is a strong and
stable foot. Only about 5% of flatfoot in adolescents and adults require treatment. There is no
evidence about the usefulness of the arch support at any age. Paediatricians should identify
and refer cases of symptomatic flatfoot while orthopaedic surgeons should provide the most
appropriate treatment, i.e. whenever possible an aetiological surgical correction. Mini-invasive
treatments are recommended when aetiology is not identifiable.