The adult-acquired flatfoot is a complex multiplanar deformity that requires the foot and ankle surgeon to balance soft tissue, correct hindfoot valgus, and address instability of the medial column. The naviculocuneiform joint is historically underappreciated in regard to its involvement in medial column instability relative to the talonavicular and tarsometatarsal joints. Proper clinical and radiographic evaluation of the medial column, specifically evaluating for deformity at each medial column joint, will allow the surgeon to ensure correction of deformity and decrease the recurrence of instability or failure of the reconstruction.
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