Consensus guidelines in the management of paediatric flexible flatfoot

Aims: The assessment and management of flexible flatfoot in children is inconsistent, reflecting a limited and heterogeneous evidence base. This study aimed to develop a British Society for Children's Orthopaedic Surgery (BSCOS)-led consensus guideline for the multidisciplinary assessment and management of flexible flatfoot in children. Methods: A modified Delphi consensus opinion study was conducted among the membership of the BSCOS. A multidisciplinary steering committee developed an initial set of statements based on clinical expertise, current evidence, and recognized variation in practice. A total of 33 statements addressing assessment, conservative, and surgical management were scored over two Delphi rounds using a nine-point Likert scale. Participant responses were anonymized. Consensus was defined prospectively as ≥ 75%. Statements that did not meet the consensus threshold were revised and rescored, or discussed and voted on by the steering committee. Results: A total of 169 clinicians participated in Round One and 167 in Round Two. Most respondents were consultant orthopaedic surgeons (80%; n = 136), with further representation from registrars/fellows (5%; n = 9), and allied health professionals (AHPs) and advanced nurse practitioners (14%; n = 24). Overall, 24 of 33 statements met the consensus threshold. A further two statements were included following steering committee voting, resulting in 26 final statements. Areas of uncertainty were highlighted in the statements that did not reach consensus, particularly regarding the selection of specific surgical procedures. Conclusion: This national consensus guideline provides a framework for clinicians managing children's flexible flatfoot, establishing a benchmark for future evaluation.