Changing concepts in the management of congenital talipes equinovarus

Clubfoot continues to affect approximately 0.89/1000 children born each year in the UK. The aetiology remains obscure but genetic and environmental factors continue to be implicated. The management of clubfoot has evolved several times over the past century but the past 10 years have seen a substantial shift away from major surgery. The current trend to treat clubfeet early with serial manipulation and casting follows publication of impressive long-term results by surgeons in Iowa, USA led by Dr Ponseti. This technique has reduced but not abolished the need for highly invasive surgery of the infant’s foot but requires an intensive level of input from practitioners and carers to achieve satisfactory levels of success. This technique also continues to require minor surgical intervention in most patients to address persistent or recurrent deformity.