Stage II flatfoot patients will complain about pain on the medial side of midfoot and hindfoot due to tendinitis and tendinosis of medial foot structure, such as, posterior tibialis tendon (PTT) and spring ligament and some will complaint the lateral midfoot and hindfoot pain due to impingement of lateral structure; the peroneus, fibula, and lateral process of the talus. There are many etiologies to explain flatfoot deformity pathology. Previously, posterior tibialis tendon dysfunction (PTTD) was known as the primary problem. Nowadays, many works of literature explain the cause of flat feet that not only the dysfunctional PTT. The reports of isolated spring ligament torn and the shortening of the calcaneus also thought to be the causes. Due to many subtypes and disease pathologies, the management in stage II flat feet are diverse. This topic will discuss the main approach of type II flatfoot and the controversies topics, such as, the amount of medial calcaneal sliding osteotomy, how to correct forefoot abduction, forefoot varus, arthroereisis, or arthrodesis.
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