In recent years, I have focused on the treatment of adult clubfoot, which is one of the more difficult ankle deformities. The etiology of clubfoot is very diverse, specifically, congenital idiopathic clubfoot, post-traumatic clubfoot, clubfoot after common peroneal nerve injury, posterior myofascial compartment of the calf, post-calf and foot crush syndrome, progressive peroneal dystrophy, post-polio, complications after limb lengthening surgery (augmentation surgery), and so on. The causes are varied and varied. The experience in the treatment of clubfoot is that the cause of the disease must first be clarified, is it congenital or acquired? Is it neurogenic or muscular in origin? What is the local soft tissue condition? Has there been previous surgery? Individualized treatment strategies should be adopted for clubfoot with different etiologies and mechanisms of occurrence. Second, the mechanism and pathology of the disease should be carefully analyzed. The classic clubfoot deformity is combined with a variety of individual deformities, such as ankle flexion, forefoot pronation, forefoot inversion, arch augmentation, hindfoot pronation, supination or claw-toe deformity, Charcot joint dislocation, and other problems, and these combined deformities can exist singly or in a mixture, presenting various challenges to the physician’s treatment. Further, the presence of the deformity should be analyzed for the presence of combined skeletal deformities. Generally, if the deformity occurs in a growing child, the deformity is combined with various skeletal deformities of the foot after adulthood, whereas horseshoe deformity secondary to neuromuscular trauma to the lower leg is rarely combined with the presence of skeletal deformities of the foot. It is also important to observe whether the structure of the tibiotalar joint is normal, especially whether the morphology of the talus matches that of the ankle joint. In long-term deformed horseshoe foot deformity, the tibial talofibular joint has been in a flexed position of deformity for too long, and the joint forms a substitute and match for the deformity, and this pathological mechanism must be considered in the correction. Based on the above preparations, the next step is how to develop a treatment plan. In developing children and adolescents without severe skeletal deformities, satisfactory results can be achieved by simply taking a tendon transposition-muscle balancing procedure. In adults with post-traumatic clubfoot, slow distraction with Ilizarov external fixator and minimally invasive Achilles tendon release can achieve satisfactory results. In addition to muscle balancing surgery for clubfoot with combined skeletal deformities, accurate foot osteotomy is required, which is a complex topic. Many doctors perform surgery without looking at the cause, or simply know a little bit of the skin to perform corrective surgery, or attend a course and perform osteotomy, ignoring the step of muscle balancing, so it is not surprising that the deformity recurs. The foot and ankle osteotomy is very demanding. In the old days, limited by the depth of understanding of foot and ankle physiology, many veteran surgeons preferred to perform triple joint fusion surgery, which could correct some of the foot and ankle deformities but, as a result, caused problems such as foot stiffness, foot length loss, and secondary arthritis. Modern foot and ankle surgery has led to a consensus among physicians that the number of joint fusions in the foot is generally minimized unless necessary.