Abstract: Pediatric flexible flatfoot (FFF) poses a clinical conundrum between over- and under-treatment due to its dual nature as a physiological developmental condition and potential risk factor for pathological decompensation. Focusing on 2 core aspects of FFF management, multidimensional assessment and stepped intervention, this review provides an overview of the representative advances and the evolution of clinical concepts in the field. In terms of assessment, new technologies, including transverse arch biomechanics, 3-dimensional quantification of foot arch volume, multisegment kinematics modeling, and smart sensor-based monitoring, may overcome the limitations of conventional static and 2-dimensional measurements and enable dynamic, multidimensional assessment of FFF in children. As for intervention, to address the limitations of a single rigid orthotic approach, clinical strategies are increasingly shifting toward a stepped pathway encompassing active biomechanical remodeling, flexible orthotic support, and precision-based surgical reconstruction. However, translating these concepts into routine clinical practice remains challenging. Most emerging assessment technologies are still largely confined to laboratory settings, and flexible interventions in children lack evidence-based support from large-scale studies. Future research should focus on evaluating the effectiveness of these approaches in real-world pediatric cohorts, establish quantitative thresholds for intervention based on multidimensional assessment, and elucidate the mechanisms underlying the selection and adaptation of different stepped interventions, thereby facilitating the standardization of clinical diagnosis and treatment of pediatric FFF.