Congenital clubfoot refers to: unilateral or bilateral foot morphology abnormalities showing inversion, inversion, and horseshoe deformity found after birth. 1. The theory of abnormal development of the primitive bone matrix: defects in the primitive germ in the talus cause persistent plantarflexion and inversion of the talus, and secondary soft tissue changes in multiple joints and muscle-tendon complexes. 2. Neuromuscular theory: primary abnormalities of soft tissue within the neuromuscular unit cause secondary bony changes and significant atrophy of the calf muscles, which do not improve significantly after treatment. The disease can be diagnosed according to the clinical manifestations, and generally does not require auxiliary confirmation: 1. X-ray examination: for the diagnosis of the degree of clubfoot deformity and objective evaluation of treatment efficacy. The anteroposterior and extreme dorsal extension lateral films of the foot are compared bilaterally, and the orthopantomograph of a child with clubfoot shows that the heel talus overlaps and both face the fifth metatarsal, and the heel talus angle disappears. 2.B ultrasound examination: It is a routine examination that can be used to diagnose horseshoe foot in infants and children, and it has a role that cannot be replaced by X-ray for the observation of cartilage. MRI and CT scan are also recommended for the preoperative and postoperative evaluation of congenital clubfoot deformity, but most children do not need to undergo these tests. 1. congenital metatarsal inversion: similar in appearance to congenital clubfoot, easily misdiagnosed, with anterior foot inversion and postural foot inversion, but without horseshoe deformity. 2. congenital vertical talus: this kind of children have foot deformity caused by abnormal talo-boat relationship, its appearance is obviously different from congenital horseshoe foot, but still pay enough attention to the child’s foot bottom can be touched an obvious raised bone, the talus head is dislocated, the ankle joint range of motion is reduced, the radiograph in extreme plantarflexion talo-boat joint is dislocated. 3. Flatfoot deformity: The child may have flat feet, which are not obvious in infancy and early childhood. However, older children may have foot pain and other discomfort, and radiographs suggest that the heel distance angle is normal and the arch disappears. No special treatment is needed. 4.Polyarticular contracture: Congenital polyarticular contracture refers to the congenital contracture of 2 or more joints at birth, and the foot may show a bilateral horseshoe inversion deformity. Most children are treated satisfactorily with early manipulation in infancy and early childhood. Treatment during the first 4 months of life is essential to improve joint mobility, maintain and enhance muscle growth, and reduce surgery. 5, neurogenic: various neurological causes of clubfoot deformity, including: spinal cord spondylolisthesis, spinal cord embolism, hereditary neurological demyelination disease, cerebral palsy sequelae, etc., such children are treated for foot deformity is more rigid and easy to recur, treatment should also be carried out early, but the postoperative need to wear a brace to maintain. Ponseti orthopedic method: It has been recognized worldwide, and its specific treatment methods are as follows (applied to children less than 2 years old): 1. (usually 4 -6 times). 2. 2. When the cast is fixed to more than 75 degrees of foot abduction, Achilles tendon release surgery can be performed. The cast is fixed for 3 weeks after surgery, and after 3 weeks the cast is removed and the orthopedic shoes are replaced. 3. Wearing Dennis-Brown orthopedic shoes after surgery for further treatment, usually until 4 years old. 2. French massage technique: Newborns should be treated immediately by manipulation, bending the knee at 90 degrees, holding the heel with one hand, pushing the front half of the foot outward with the other hand to correct forefoot adduction, followed by holding the heel for valgus, and finally the palm of the Yee hand dragging the sole of the foot for dorsal extension to correct the horseshoe, with multiple manipulations daily until the deformity is corrected. V. Surgical treatment But for children who miss the timing of non-surgical orthopedic treatment or children who wear orthopedic brace after orthopedic treatment due to the failure to follow medical prescriptions causing recurrence of deformity, the corresponding symptomatic surgical treatment will be carried out according to their different conditions: 1, extensive soft tissue release: the general principles of any phase of extensive release for the treatment of clubfoot include: 2, Achilles tendon lengthening: for children who miss the age of Achilles tendon release surgery ( Generally 2-3 years old) need to release the Achilles tendon, so that the heel bone drop needs to be performed Achilles tendon lengthening, the Achilles tendon line z incision. Postoperative cast immobilization for 6 weeks. 3, tibialis anterior muscle external transfer: for children with early mild recurrence of clubfoot, or residual forefoot inversion deformity after treatment. 4.External fixation brace: For children with stiff clubfoot of older age (generally above 5 years old), the foot bones have ossified and the deformity cannot be corrected by soft tissues alone, external fixation brace technique can be used, and the brace needs to be adjusted periodically after surgery, and the appearance is basically satisfactory, but there will be residual foot and ankle stiffness. 5.Foot osteotomy orthopedic surgery: there are many surgical methods, generally the child is older than 5 years old, according to its deformity, choose different parts of the osteotomy, can be combined with external fixation bracket to correct horseshoe inversion deformity. 6.Triple joint fusion: indications: children over 10 years old; combined with three deformities of metatarsal inversion, hindfoot inversion and plantar flexion; this operation can be considered. 7.For difficult cases, Ilizarov technique can produce miraculous results.