An understanding of the natural history; a careful physical examination including range of motion, neurovascular examination, visual inspection, and palpation; and serial measurements allow proper diagnosis for most pedal (foot) deformities. Most importantly, the timing of presentation is critical. Congenital pedal deformities include metatarsus adductus, metatarsus varus, calcaneovalgus foot, rocker-bottom foot (congenital vertical talus), and clubfoot (talipes equinovarus). Pes planus (flatfeet) may be of either the soft or the rigid variety, and both are typically noticed as the child begins to ambulate. Flat feet are common in children because arch development occurs primarily before 4 years of age, and because the development has a wide variation in the rate or onset in any given child. The treatment of these defects is overwhelmingly conservative, and surgery is reserved for older children with severe deformities that will not improve over time.

• Intoeing and outtoeing may result from more proximal, tibial, femoral, or hip defects, such as long bone torsion, bowlegs, or knock-knees.

• While the majority of clubfoot and pes planus deformities are sporadic, these deformities have also been linked to inherited defects.

• The timing of ambulation in children with metatarsus adductus and pes planus is not generally delayed.

• Metatarsus adductus is the most common congenital foot deformity. It occurs more frequently in women, is more common on the left side than on the right side, and typically improves with time.

• Metatarsus adductus, clubfoot, and flexible pes planus are infrequently associated with pain, whereas rigid pes planus may be associated with significant discomfort.

• Trauma, occult infection, a foreign body, tarsal coalition, bone tumors, or osteochondrosis of the tarsal navicular bone may cause a stiff and painful flat foot.

• The presence of systemic symptoms, such as fever, may be suggestive of more serious foot disorders, such as infection or malignancy.

• When metatarsus adductus is also associated with hindfoot inversion, plantar flexion, a hypoplastic ipsilateral calf, or a slightly shortened tibia, a diagnosis of clubfoot should be considered.

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