The causes of clubfoot deformity are complex, the types of deformity are varied and often co-exist with other parts of the body, and there are hundreds of surgical treatments. Clinical treatment decision-making is just like this ever-changing world, searching for the unchanging truth amidst the changes. In Xunzi’s “Advice to Learning”, it is said, “The wood is straight in the rope, and the wheel is curved in the rule.” “, Mengzi Li Lou on” said “: Li Lou’s bright, out of the loss of the child’s skill, not by the rules, can not become a square circle.” Therefore, to make rules, master the law, must be based on the patient’s specific situation and foot deformity change rule, the horseshoe foot classification, in order to treatment decision-making and efficacy evaluation. 1, horseshoe foot classification according to the cause of deformity can be horseshoe foot deformity is divided into: congenital horseshoe foot; paralytic horseshoe foot; traumatic horseshoe and spasmodic horseshoe foot and other types. This article focuses on the classification and treatment strategies of congenital, paralytic and spastic clubfoot and clubfoot. 1.1 Paralytic horseshoe foot deformity Horseshoe foot and clubfoot deformity is a common deformity, which manifests itself as: foot drop, mid-front foot inversion, heel inversion and pronation. Achilles tendon contracture, high arched feet, toe dorsiflexion, metatarsal head weight-bearing, may be accompanied by supination foot deformity. The causes are complex and often co-exist with other lower limb deformities. Professor Qin Sihe, a famous orthopedic surgeon, categorized them into clubfoot deformity and clubfoot inversion deformity], in order to facilitate the formulation of surgical plan and improve the therapeutic efficacy. According to the causes of clubfoot and the main parts of the deformity, it is classified into: (1) Achilles tendon contracture clubfoot: there is no obvious deformity of the bone and joint of the foot; (2) high arching of the appendicular bone: all of them are combined with metatarsophalangeal tendon membrane contracture; (3) metatarsal head ptosis clubfoot: it is mainly the ptosis of the first metatarsal head and arching change of metatarsophalangeal cuneiform joint; (4) composite type of clubfoot: there are more than 2 deformities, and is the most common type of adult; (5) composite foot: there are more than 2 deformities; and the most common type of adult; (6) composite foot: there are more than 2 deformities, and is the most common type of adult; and the most common type of adult; and the most common type of adult. (5) Achilles tendon paralyzed clubfoot: there is both paralysis of the triceps muscle of the lower leg and obvious drop foot deformity. Types of clubfoot (Qin’s typing): According to the degree of clubfoot, deformity and clinical manifestations, and the site of foot pressure, clubfoot is divided into 4 types: (1) Ankle-foot joint laxity of clubfoot: the performance of the Achilles tendon contracture, but the tarsal interphalangeal joints of the foot laxity, the weight-bearing was in the position of the horse’s hooves inward turned, but with the hand will be turned outward passively and its inward turning deformity of the foot can be corrected. It is mainly seen in children and adolescents or those with extensive paralysis of ankle and foot muscles. (2) Horseshoe pronation: The contracture of the Achilles tendon is more severe, and the pronation deformity is mainly manifested in the forefoot, accompanied by contracture of the metatarsal tendon membrane, and there is no fixed pronation of the heel bone. The foot is weight-bearing with the anterior lateral edge of the foot. (3) Horseshoe Rearfoot Hallux Valgus: In this type, the posterior tibialis muscle is paralyzed, the Achilles tendon contracture and the inversion deformity is mild, and the inversion of the foot is in the heel bone without fixed inversion of the forefoot. (4) Horseshoe total foot hallux valgus: the whole foot has hallux valgus, and almost all of them have osteoarthritic deformity of the foot after adolescence. However, there are some differences in muscle balance, contracture of the soft tissues of the posterior medial side of the foot, and the type, degree, and characteristics of inversion of the foot, with the mild cases landing on the ground with the outer edge of the foot. In severe cases, only the dorsum of the foot to walk on the ground, in the dorsum of the foot heavy parts of the formation of a large callus. 1.2 Congenital clubfoot congenital clubfoot can be found after birth or gradually appear deformity, and congenital factors. There are different types of congenital clubfoot, but the clinical manifestations after birth have common characteristics. It is characterized by ankle and heel drop and inversion, and midfoot and forefoot inversion. There is a wide range of classifications, including X-ray, pathologic, and anatomic, with varying degrees of severity and treatment. The lack of a widely used and standardized classification system to evaluate the preoperative severity of deformity and postoperative outcome of clubfoot hinders the comparison of treatment results. Numerous clinical classification schemes have been proposed, including those of Carroll, Goldern and Catterall. Recently, two additional classification schemes have been proposed by Pirani et al. and Dimeglio et al., which are based on physical examination alone and do not require radiographic or other specialized investigations. Although these two systems have proved to be reliable, they are not yet universally accepted. A standardized scoring system for pre-treatment deformity and post-treatment outcome would help to determine whether different treatments can be more accurately evaluated and compared. Currently, there are three types of deformities that are categorized according to clinical presentation. 1. 2. 1 Postural clubfoot: The foot is in a clubfoot position but is soft and can be easily corrected to a neutral, dorsiflexed or valgus position. The relationship between the bones is normal, and the gap between the medial ankle and navicular bone is palpable. The heel is obvious, and the calf muscles are normal or slightly atrophied. The dorsiflexion and valgus muscles could be actively contracted. 1. 2. 2 Recoverable clubfoot: the deformity is more obvious, the passive correction can not be completely corrected to the neutral, dorsiflexion and valgus position, but it is softer. There is an abnormal change in the relationship of the bones. The prominent talus is palpable on the dorsum of the foot, the navicular bone is displaced medially but a gap is palpable between the medial malleolus and the navicular bone, and the forefoot is at rest in an inversion position of approximately 56°. The dorsolateral skin folds and heel were evident. There were no deep skin folds on the plantar or posterior aspect of the foot, and the calf muscles were mildly atrophied. 1. 2. 3 Rigid clubfoot: the deformity is very obvious, with the forefoot turned in at an angle of 90° to the tibia. The talus is obviously protruding from the dorsum of the foot under the skin. The navicular bone is displaced to the medial side of the talus head. There is no gap between the deep medial aspect of the foot and the inner ankle. Dice bone is obviously protruding to the lateral side, and the forefoot is in an inward turning position. The heel bone is plantarflexed and turned inward, and the posterior part is hidden upward between the tibiofibula, the appearance of the heel seems to be small, and there are deep skin folds on the medial side and the sole of the foot. The skin of the whole foot is thin and lacks subcutaneous fat. The calf muscles are markedly atrophied. 1.3 Spastic clubfoot is categorized according to the degree of muscle spasm, the ability to control at will, the status of antagonist muscles, and the presence or absence of fixed deformity. Spasticity of the calf triceps may be accompanied by spasticity of other muscles. 1. 3. 1 Deformity characterized by spasticity of the tibialis anterior muscle: the forefoot is pronated and the heel is inverted. During the whole cycle of gait, the foot is in a horseshoe inversion position, with dorsiflexion and external rotation and subcutaneous protrusion of the tibialis anterior tendon. It is often accompanied by bunion and toe deformity, which is a dynamic deformity with myospasm. 1. 3. 2 Deformity characterized by spasticity of the posterior tibialis muscle: forefoot pronation, inversion of the heel bone, and a positive toe-tip test. Subcutaneous protrusion of the posterior tibial tendon is seen throughout the gait cycle, and the foot is in a horseshoe inversion position, which is a dynamic deformity. The foot is in a horseshoe inversion, which is a dynamic deformity. It is accompanied by partial flexion of the knee, positive ankle clonus, and a partial clipped gait. 1. 3. 3 Deformity in which spasticity of the posterior tibialis muscle and anterior tibialis muscle coexist: the tendon is clearly raised under the skin. The clubfoot is often in a state of constant spasm. Continuous muscle spasm, forefoot inversion, talus subluxation, heel inversion, bony deformity fixation, are horseshoe deformity, ankle clonus is positive. Surgical treatment strategy of clubfoot deformity The purpose of typing is for better treatment, and the design and implementation of a good surgical program should achieve: no pain in the foot; ability to use the soles of the foot to bear weight; beautiful gait and appearance; ability to wear normal shoes; the foot should be flexible; and the patient and his family are satisfied. The latter is the most important. 2.1 Surgical treatment strategy for paralyzed clubfoot deformity In the correction of clubfoot deformity, first of all, we should remove the various factors that cause and affect the development of clubfoot deformity, and choose different surgical methods according to different types of clubfoot. The goal of correction is to correct clubfoot deformity completely in children and adolescents, moderately in young people, adults or those with weak calf triceps muscle strength, without weakening of walking function and pain in ankle and foot joints after correction of clubfoot deformity. 2. 1. 1 Achilles tendon contracture horseshoe foot: the Achilles tendon lengthening operation is performed to correct, but some adult patients have degeneration of the articular surface in front of the talus due to long term disuse, after the Achilles tendon lengthening, the degenerated articular surface is transferred to the ankle joints to produce pain, this kind of patients with Achilles tendon lengthening correction of horseshoe deformity is suitable to control the deformity within 40 °, and adults with severe horseshoe deformity should be added to do the correction of the triple fusion of the Lambrinudi joints. 2.1.2 Horseshoe foot with high tarsal arches