Operative intervention for juvenile flexible flatfoot is considered after a protracted course of orthotics and shoe modifications have failed to relieve associated symptoms. Surgical treatment options include hindfoot fusion, soft tissue procedures, calcaneal osteotomies, limited midtarsal arthrodeses, combination techniques, and subtalar arthroereisis. Long-term, high success rates have been documented with use of combination procedures and the anterior calcaneal osteotomy of Evans.