History of clubfoot treatment; part III (twentieth century): back to the future

Clubfoot is one of the most common congenital orthopaedic anomalies and was described by Hippocrates in the year 400 BC. From manipulation in antiquity to splint and plaster in the Renaissance the treatment had improved before tenotomy. Many surgical treatments were tested during the nineteenth and twentieth centuries and will be explained in this manuscript; however, the pathology still continues to challenge the paediatric orthopedic surgeon as it has a notorious tendency to relapse, irrespective of whether the foot is treated with conservative or operative means. Part of the reason that the foot relapses is the surgeon’s failure to recognize the underlying pathoanatomy. Clubfoot is often automatically assumed to be an equinovarus deformity, however, other permutations and combinations, such as calcaneovalgus, equinovalgus and calcaneovarus, are possible. Out of these combinations, calcaneovalgus occurs most frequently, followed by equinovarus deformity. In more than 90% of the cases, calcaneovalgus responds to conservative treatment, which involves passive manipulation and usually does not require casting or operative intervention as has been demonstrated by Ponseti.