A, Preoperative standing anteroposterior radiographs of ankle in an 8-year, 6-month-old boy with symptomatic flexible pes planus. Note valgus alignment of tibiotalar axis (11 degrees valgus), increased fibular station (station 1), and distal tibial epiphyseal wedging (index 0.55). Standing anteroposterior (B) and lateral (C) radiographs 1 year, 3 months after placement of transphyseal medial malleolar screw. Tibiotalar axis is improved (3 degrees varus), whereas fibular station and epiphyseal wedging are unchanged. Note position of screw in both planes, subtle distal tibial metaphyseal deformity, and obliquity of physis created by screw. D, Standing anteroposterior radiograph of ankle 1 year, 4 months after screw removal. With release of medial tether and resumption of complete physeal growth, ankle valgus recurred (6 degrees valgus). (From Davids JR, Valadie AL, Ferguson RL, et al: Surgical management of ankle valgus in children: use of a transphyseal medial malleolar screw, J Pediatr Orthop 17:3, 1997.) SEE TECHNIQUE 34.33.