Background: Severe flexible flatfoot [FFF] in children can cause long-term disability if left untreated. Various surgical techniques have been described to correct the deformity. However, no surgical technique is universally accepted.
Aim of the work: The aim of this study is to evaluate the clinical and radiological outcomes of a combined reconstructive procedure involving rerouting of the tibialis anterior tendon for severe flexible flatfoot in children.
Patients and Methods: This prospective study included 20 children [35 feet] with severe FFF who underwent a combined procedure involving medializing calcaneal osteotomy, lateral column lengthening, and rerouting of the tibialis anterior tendon. Clinical assessment and radiographic evaluation of talo‑first metatarsal [T1MT] angle, Meary's angle and calcaneal pitch were done preoperatively and at final follow-up [minimum 6 months]. Evaluation of function was done using the American Orthopedic Foot & Ankle Society [AOFAS] score. 
Results: There was significant improvement in the mean AOFAS score from 52.5 ± 13.5 preoperatively to 87 ± 7.8 at final follow-up. The mean T1MT angle improved from 17.29° ± 4.32° to 6.66° ± 4.1° and calcaneal pitch from 8.63° ± 2.51° to 21.43° ± 4.95°. No major complications were encountered.
Conclusion: Rerouting of the tibialis anterior tendon as an adjunct to combined reconstructive procedure provided satisfactory clinical and radiological outcomes in management of severe flexible flatfoot in children with minimal complications.