Treatment of congenital clubfoot is better as early as possible and should be started right after birth. The neonatal period is the best time to treat congenital clubfoot. Treatment methods include non-surgical treatment and surgical treatment. 1, non-surgical treatment should be carried out as soon as possible after birth manipulation, plaster and splint fixation, in order to correct the deformity. This method takes a long time and has a certain recurrence rate. It is mainly applied to patients with floppy type and some stiff type within 6 months. In infants under 6 months of age, fasting for 4h before surgery, usually without anesthetics, the deformity is first corrected by gentle manipulation and massage. One hand fixes the heel and the other hand corrects the pronation and forefoot inversion. Then the corrected position was maintained, breastfeeding was started to keep the infant quiet, and a long-legged tubular cast was used to keep the knee flexed at 40° and the ankle in the corrected position, and manipulation and cast fixation were performed once a week. After the inversion deformity was completely corrected, the plantar flexion deformity was finally corrected, and care was taken not to destroy the arch by forceful moving. After the deformity is completely corrected, the last cast will be fixed for one month. After correction of the deformity, there is still a tendency of recurrence, after removing the external fixation, measures should be taken to maintain and consolidate the corrected deformity. The Dennis-Browne brace should continue to be fixed until the child is 1 year old. Orthopedic shoes should be worn until the child is able to walk normally. Observation until adolescence, if the deformity does not recur, it is stable. 2, surgical treatment Surgical treatment is mainly used for non-surgical treatment of deformity correction is not satisfactory or recurrence cases and older children without correction cases. Surgery should be performed as early as possible after 4-6 months after birth. There are many surgical options, including soft tissue surgery, bony surgery, combined soft tissue and bony surgery and the four-dimensional phase correction method that applies the principle of tensile stress in recent years. The application should be selected according to the patient’s age, type and degree of lesion. (1) Turco posterior and medial soft tissue release This procedure aims to remove and release the posterior and medial contracted soft tissues that hinder orthopedics, restore the normal bony relationship, reset the navicular bone, and fix the talocalcaneal joint with a kerf pin through the first metatarsal bone, the first cuneiform bone, the navicular bone and the talus. The age of surgery should be 1 to 2 years old. The recurrence rate of soft tissue release alone is as high as 50%. (2) Mckay posterior, medial and lateral release Mckay proposed the new concept of rotation of the talofibular joint of the affected foot in all three planes based on the pathological anatomical observation of surgery in 1982, and designed the posterior, medial and lateral release, and achieved good results. He observed that the talocalcaneal joint of congenital clubfoot was deformed in all three planes, i.e., foot drop in the sagittal plane, heel inversion in the coronal plane, and internal rotation in the horizontal plane of the talocalcaneal joint. Mckay’s procedure focuses on the correction of the inward rotation of the talocrural joint in the horizontal plane by completely releasing the talocrural joint and related tissues, and using the interosseous ligament as the axis to externally rotate the talocrural joint in the horizontal direction, so that the longitudinal axis of the plantar aspect of the foot and the longitudinal axis of the thigh (prone position, 90° of knee flexion) can be restored to a normal relationship. The longitudinal axis of the plantar foot is restored to the normal relationship with the longitudinal axis of the thigh (prone position, 90° of flexion). After the operation, the appearance and gait are good and there is no deformity of the internal “eight” foot. The best results can be achieved at the age of 1-4 years old and up to 8 years old. (3) Early correction of deformity and establishment of muscle balance surgery Professor Lu Yupu and others observed through years of clinical and experimental research that the main cause of congenital clubfoot is congenital muscle imbalance and secondary soft tissue and bone joint lesions. It is believed that in the early stage, i.e., before the formation of secondary osteoarthrosis or when the secondary lesions are mild, the deformity is easy to correct and the muscle balance of the medial and lateral foot and metatarsal and dorsal side should be established while correcting the deformity, which facilitates the maintenance of the corrected position. In more advanced cases, a small range of osteoarthritic deformity correction is added, and the same principle is applied to establish muscle balance to maintain the corrected position. This procedure is safe, simple, and can be tolerated by infants from 4 to 6 months of age, and the development and function of the foot is good after surgery. It is suitable for uncorrected or incompletely corrected deformities from 4 months to 5 years of age, and can also be used for some children from 6 to 10 years of age. The clinical application of nearly 2000 feet has shown satisfactory long-term results. For infants under 1 year old, the surgery is performed by subcutting the Achilles tendon attachment, transferring the tibialis anterior muscle to the 3rd cuneiform bone or the medial side of the dice bone, fixing it with the pull-out wire method, fixing the knee joint flexion at 30°, ankle dorsiflexion at 10° and mild external booth of the forefoot for 6 weeks in a long-legged tubular cast, then removing the cast and pulling out the wire to complete the treatment, and gradually walking. The scope of surgery increases gradually with age. Generally, the Achilles tendon is lengthened by the open method, i.e., the Z-shaped lengthening of the anterior and posterior flaps of the Achilles tendon, which often requires simultaneous incision of the posterior joint capsule of the ankle joint and the talofibular joint. If the posterior tibial, long flexor and long toe flexor muscles are tight, a Z-lengthening is also required. The medial capsule of the first metatarsophalangeal joint is incised, and the medial capsule of the cuneiform and talar joints are incised if necessary. The anterior tibial muscle is moved externally to the medial side of the 3rd cuneiform or dice bone. In a few patients with hypoplasia or even absence of this muscle, the posterior tibial muscle is transferred via the interosseous membrane to attach to the above bones. If the forefoot is severely pronated, in addition to incision of the medial joint capsule, it is often necessary to make a wedge-shaped excision of the dorsal and lateral dice bones to correct the forefoot pronation deformity by manipulation, and then transfer the tibialis anterior muscle to establish muscle balance. Early surgery, complete release to correct the deformity, and the establishment of dynamic muscle balance on this basis is the key to a good outcome. Plantar flexion, pronation and forefoot inversion deformity need to be corrected intraoperatively, and calf internal rotation deformity, after foot deformity correction, can be gradually corrected on its own during development, and surgical correction is generally not necessary. (4) Four-dimensional phase correction of severe clubfoot Ilizarov proposed a new concept and theory of “distraction histogenesis” in 1989, that is, slow distraction of living tissues to generate stress can stimulate and maintain regeneration and active growth of certain tissues, which is also called the principle of tensile stress. In recent years, the application of this theory and Ilizarov external fixation device has achieved good results in the correction of severe clubfoot. Since the foot and the Ilizarov external fixation device have the same three-dimensional structure, this device can be applied to fix the foot and correct its deformity in three dimensions. However, this method is different from the previous surgical method which tries to complete the three-dimensional correction of the deformity in a single surgical procedure. It applies the principle of tensile stress to increase the adjustable variable of time, starting at 1 mm/d and divided into 4 increments of 0. 25 mm each time, and if it can be tolerated, the correction speed can also be appropriately accelerated, and the three-dimensional correction is performed by slowly stretching multiple planes, thus it is a four-dimensional phase correction method. There are two ways of this method: a. The non-cutting method is suitable for cases with normal joint surface relationship and no fixed bone deformity, but it can still be used for cases under 8 years old with fixed bone deformity because the bones of the foot may still be reshaped; b. The cutting and stretching method is suitable for cases over 8 years old with fixed bone deformity. It is applied with Ilizarov external fixation device for slow distraction and “U” shaped osteotomy or “V” shaped osteotomy to achieve correction of each deformity factor of clubfoot. If there is muscle imbalance, muscle balance must still be established after the deformity is corrected. This method is effective for the correction of severe clubfoot and can maintain the length and function of the affected foot. (5) Triple joint fusion is suitable for 12-14 years old and above and adults, and the three joints of the foot (i.e. heel talus, heel dice and talar navicular joint) are osteotomized in a wedge shape to correct pronation, adduction and plantar flexion deformity. After surgery, the foot is fixed in a functional position for 3 months with a long-legged tubular cast.