This 2002 JAAOS narrative review by Roye and Roye covers idiopathic congenital talipes equinovarus comprehensively. It addresses epidemiology, morbid anatomy, classification, nonsurgical and surgical management, complications, and outcomes assessment. The paper synthesizes the state of knowledge at publication and frames ongoing controversies in casting technique and surgical release.
When you see a newborn with clubfoot, your first decision is how aggressive to be with casting — and the Harrold-Walker grade tells you what to expect. A Grade I foot has an 89% chance of correcting with serial casting. A Grade III foot has only a 10% chance. Set those expectations with the family on day one.
If you use the Ponseti method, counsel families that "non-surgical" still means procedures for most children: 70% need an Achilles tenotomy and half need a tendon transfer. More importantly, the protocol requires nightly bracing for years, and noncompliance is the leading cause of recurrence in populations where follow-through is difficult.
When casting fails and you go to the OR, get the correction order right: adduction first, then varus, then equinus. And resist the urge to over-release. Overcorrection (hindfoot valgus, pes planus, calcaneus deformity) is documented as harder to fix than undercorrection, and aggressive wide subtalar release is what drives it.
For any prenatal ultrasound diagnosis, order amniocentesis: 14.2% of these fetuses have an associated genetic anomaly.
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This 2002 JAAOS narrative review by Roye and Roye covers idiopathic congenital talipes equinovarus comprehensively. It addresses epidemiology, morbid anatomy, classification, nonsurgical and surgical management, complications, and outcomes assessment. The paper synthesizes the state of knowledge at publication and frames ongoing controversies in casting technique and surgical release.
When you see a newborn with clubfoot, your first decision is how aggressive to be with casting — and the Harrold-Walker grade tells you what to expect. A Grade I foot has an 89% chance of correcting with serial casting. A Grade III foot has only a 10% chance. Set those expectations with the family on day one.
If you use the Ponseti method, counsel families that "non-surgical" still means procedures for most children: 70% need an Achilles tenotomy and half need a tendon transfer. More importantly, the protocol requires nightly bracing for years, and noncompliance is the leading cause of recurrence in populations where follow-through is difficult.
When casting fails and you go to the OR, get the correction order right: adduction first, then varus, then equinus. And resist the urge to over-release. Overcorrection (hindfoot valgus, pes planus, calcaneus deformity) is documented as harder to fix than undercorrection, and aggressive wide subtalar release is what drives it.
For any prenatal ultrasound diagnosis, order amniocentesis: 14.2% of these fetuses have an associated genetic anomaly.