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This is a short clip of a pediatric flatfoot with midtarsal joint instability due to severe tightness in the calf and Achilles. This is a video taken in the operating room. The patient had flatfoot surgery with percutaneous Achilles lengthening and subtalar implant (arthroeresis). As you can see at the beginning of the video, the Left foot moves up and down smoothly after Achilles lengthening and correction of the flatfoot with a subtalar joint implant (arthroeresis). The tightness in the calf is a deforming force in the foot. To compensate for the tightness, the foot becomes unstable and slides up and out, further flattening the arch. This is called midtarsal joint instability. This is shown in the video instead of having fluid motion up and down at the ankle with the foot held in a neutral position. A subtalar joint implant (arthroeresis) is performed at the same time of the Achilles lengthening to correct the flatfoot. During this video, you can see the difference of the flexibility and position of the foot between a corrected and uncorrected foot. This procedure and video was brought to you by Foot, Ankle and Leg Specialists of South Florida in conjunction with South Florida Institute of Sports Medicine, Weston, Fl. Please visit our website at www.southfloridasportsmedicine.org