Introduction

Clubfoot or congenital talipes equinovarus is a congenital birth abnormality affecting feet which causes cosmetic abnormality and progressive difficulty in walking. In most cases etiology is unknown even though there are many theories regarding the same. It is said to be seen in 1 out of 1000 live births.

It is managed now with Ponseti technique developed by Ignacio V. Ponseti in the 1940s. One of the major principles of this technique is the concept that the tissues of a new-born’s foot, including tendons, ligaments, joint capsules, and certain bones, will yield to gentle manipulation and casting of the feet at weekly intervals. This has brought a drastic change in the treatment and hence has improved the results of clubfoot treatment without resorting to major surgeries.

This treatment is economical and when implemented correctly, will significantly result in deformity correction in children with clubfoot. Major manipulation and surgical procedures are avoided. The feet gets improved in appearance and function. Also the long term complications of uncorrected feet like osteoarthritis and painful bursitis don’t happen with this treatment.

Aim of the Study

The aim of our study is to explore the functional outcome of Ponseti method for the management of congenital talipes equinovarus in children less than 12 months who attended at club foot clinic of orthopaedic outpatient department, medical college Thiruvananthapuram. 

1. Wynne-Davies R. Family Studies And The Cause of Congenital Club Foot. Talipes Equinovarus, Talipes Calcaneo-Valgus And Metatarsus Varus. J Bone Joint Surg Br. 1964 Aug;46:445-63.
2. A Dimeglio FB. Dimeglio A, Bonnet F, Mazeau P, DeRosa V. Orthopaedic treatment and passive motion machine: consequences for the surgical treatment of clubfoot. J Pediatr Orthop B. 1996;5(3): 173-80.
3. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980 Jan;62(1):23-31.
4. Dimeglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. Pediatr Orthop Part B. 1995;4(2):129-36.
5. Flynn JM, Donohoe M, Mackenzie WG. An independent assessment of two clubfoot-classification systems. J Pediatr Orthop. 1998 Jun;18(3):323-7.
6. Wynne-Davies R. Family Studies and the Cause of Congenital Club Foot. J Bone Joint Surg Br. 1964 Aug 1;46-B(3):445-63.
7. Bakalis S, Sairam S, Homfray T, Harrington K, Nicolaides K, Thilaganathan B. Outcome of antenatally diagnosed talipes equinovarus in an unselected obstetric population. Ultrasound Obstet Gynecol. 2002 Sep 1;20(3):226-9.
8. Gurnett CA, Boehm S, Connolly A, Reimschisel T, Dobbs MB. Impact of congenital talipes equinovarus etiology on treatment outcomes. Dev Med Child Neurol. 2008 Jul;50(7):498-502.
9. Gordon N. Arthrogryposis multiplex congenita. Brain Dev. 1998 Oct;20(7):507-11.
10. Hootnick DR, Levinsohn EM, Crider RJ, Packard DS. Congenital arterial malformations associated with clubfoot. A report of two cases. Clin Orthop. 1982 Jul;(167):160-3.
11. Dunn PM. Congenital postural deformities: perinatal associations. Proc R Soc Med. 1972 Aug;65(8):735-8.
12. Bonnell J, Cruess RL. Anomalous Insertion of the Soleus Muscle as a Cause of Fixed Equinus Deformity. J Bone Jt Surg Am. 1969 Jul 1;51(5):999-1000.
13. Gurnett CA, Alaee F, Kruse LM, Desruisseau DM, Hecht JT, Wise CA, et al. Asymmetric Lower-Limb Malformations in Individuals with Homeobox PITX1 Gene Mutation. Am J Hum Genet. 2008 Nov 17;83(5):61622.
14. Lochmiller C, Johnston D, Scott A, Risman M, Hecht JT. Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998 Sep 1;79(2):90-6.
15. Beals RK. Club foot in the Maori: a genetic study of 50 kindreds. N Z Med J. 1978 Aug 23;88(618):144-6.
16. Chung CS, Nemechek RW, Larsen LI, Ching GH. Genetic and epidemiological studies of clubfoot in Hawaii. General and medical considerations. Hum Hered. 1969;19(4):321-42.
17. Wynne-Davies R. Genetic and environmental factors in the etiology of talipes equinovarus. Clin Orthop. 1972 May;84:9-13.
18. Rebbeck TR, Dietz FR, Murray JC, Buetow KH. A single-gene explanation for the probability of having idiopathic talipes equinovarus. Am J Hum Genet. 1993 Nov;53(5):1051-63.
19. Wang JH, Palmer RM, Chung CS. The role of major gene in clubfoot. Am J Hum Genet. 1988 May;42(5):772-6.
20. de Andrade M, Barnholtz JS, Amos CI, Lochmiller C, Scott A, Risman M, et al. Segregation analysis of idiopathic talipes equinovarus in a Texan population. Am J Med Genet. 1998 Sep 1;79(2):97-102.
21. Chapman C, Stott NS, Port RV, Nicol RO. Genetics of club foot in Maori and Pacific people. J Med Genet. 2000 Sep 1;37(9):680-3.
22. Kruse LM, Dobbs MB, Gurnett CA. Polygenic threshold model with sex dimorphism in clubfoot inheritance: the Carter effect. J Bone Joint Surg Am. 2008 Dec;90(12):2688-94.
23. Philip J, Silver RK, Wilson RD, Thom EA, Zachary JM, Mohide P, et al. Late first-trimester invasive prenatal diagnosis: results of an international randomized trial. Obstet Gynecol. 2004 Jun;103(6):1164-73.
24. Tredwell SJ, Wilson D, Wilmink MA, Canadian Early and Mid-Trimester Amniocentesis Trial Group (CEMAT), and the Canadian Pediatric Orthopedic Review Group. Review of the effect of early amniocentesis on foot deformity in the neonate. J Pediatr Orthop. 2001 Oct;21(5): 636-41.
25. Honein MA, Paulozzi LJ, Moore CA. Family history, maternal smoking, and clubfoot: an indication of a gene-environment interaction. Am J Epidemiol. 2000 Oct 1;152(7):658-65.
26. Hecht JT, Ester A, Scott A, Wise CA, lovannisci DM, Lammer EJ, et al. NAT2 variation and idiopathic talipes equinovarus (clubfoot). Am J Med Genet A. 2007 Oct 1;143A(19):2285-91.
27. Karakurt L, Yilmaz E, Serin E, Bekta§ B, Cikim G, Giirsu F. Plasma total homocysteine level in mothers of children with clubfoot. J Pediatr Orthop. 2003 Oct;23(5):658-60.
28. Sharp L, Miedzybrodzka Z, Cardy AH, Inglis J, Madrigal L, Barker S, et al. The C677T polymorphism in the methylenetetrahydrofolate reductase gene (MTHFR), maternal use of folic acid supplements, and risk of isolated clubfoot: A case-parent-triad analysis. Am J Epidemiol. 2006 Nov 1;164(9):852-61.
29. Wang L-L, Fu W-N, Li-Ling J, Li Z-G, Li L-Y, Sun K-L. HOXD13 may play a role in idiopathic congenital clubfoot by regulating the expression of FHL1. Cytogenet Genome Res. 2008;121(3- 4):189-95.
30. Heck AL, Bray MS, Scott A, Blanton SH, Hecht JT. Variation in CASPIO gene is associated with idiopathic talipes equinovarus. J Pediatr Orthop. 2005 Oct;25 (5):598-602.
31. Shapiro MD, Marks ME, Peichel CL, Blackman BK, Nereng KS, Jonsson B, et al. Genetic and developmental basis of evolutionary pelvic reduction in threespine sticklebacks. Nature. 2004 Apr 15;428(6984):717-23.
32. Sung SS, Brassington A-ME, Grannatt K, Rutherford A, Whitby FG, Krakowiak PA, et al. Mutations in genes encoding fast-twitch contractile proteins cause distal arthrogryposis syndromes. Am J Hum Genet. 2003 Mar;72(3):681-90.
33. Sung SS, Brassington A-ME, Krakowiak PA, Carey JC, Jorde LB, Bamshad M. Mutations in TNNT3 Cause Multiple Congenital Contractures: A Second Locus for Distal Arthrogryposis Type 2B. Am J Hum Genet. 2003 Jul;73(1):212-4.
34. Toydemir RM, Rutherford A, Whitby FG, Jorde LB, Carey JC, Bamshad MJ. Mutations in embryonic myosin heavy chain (MYH3) cause Freeman-Sheldon syndrome and Sheldon-Hall syndrome. Nat Genet. 2006 May;38(5):561-5.
35. Veugelers M, Bressan M, McDermott DA, Weremowicz S, Morton CC, Mabry CC, et al. Mutation of perinatal myosin heavy chain associated with a Carney complex variant. N Engl J Med. 2004 Jul 29;351(5):460-9.
36. Gurnett CA, Alaee F, Desruisseau D, Boehm S, Dobbs MB. Skeletal muscle contractile gene (TNNT3, MYH3, TPM2) mutations not found in vertical talus or clubfoot. Clin Orthop. 2009 May;467(5):1195-200.
37. Boehm S, Limpaphayom N, Alaee F, Sinclair MF, Dobbs MB. Early results of the Ponseti method for the treatment of clubfoot in distal arthrogryposis. J Bone Joint Surg Am. 2008 Jul;90(7):1501-7.
38. Turco VJ. Surgical Correction of the Resistant Club Foot. J Bone Jt Surg Am. 1971 Apr 1;53(3):477-97.
39. Turco VJ. Resistant congenital club foot--one-stage posteromedial release with internal fixation. A follow-up report of a fifteen-year experience. J Bone Jt Surg Am. 1979 Sep 1;61(6):805-14.
40. Hudson I, Catterall A. Posterolateral release for resistant club foot. J Bone Joint Surg Br. 1994 Mar;76(2):281-4.
41. McKay DW. New concept of and approach to clubfoot treatment: section I-principles and morbid anatomy. J Pediatr Orthop. 1982 Oct;2(4):347-56.
42. Simons GW. Complete subtalar release in club feet. Part II--Comparison with less extensive procedures. J Bone Joint Surg Am. 1985 Sep;67(7):1056-65.
43. Atar D, Lehman WB, Grant AD. Complications in clubfoot surgery. Orthop Rev. 1991 Mar;20(3):233-9.
44. Weseley MS, Barenfeld PA, Barrett N. Complications of the treatment of clubfoot. Clin Orthop. 1972 May;84:93-6.
45. Aronson J, Puskarich CL. Deformity and disability from treated clubfoot. J Pediatr Orthop. 1990 Feb;10(I):109-19.
46. Dobbs MB, Nunley R, Schoenecker PL. Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release. J Bone Joint Surg Am. 2006 May;88(5):986-96.
47. Hutchins PM, Foster BK, Paterson DC, Cole EA. Long-term results of early surgical release in club feet. J Bone Joint Surg Br. 1985 Nov;67(5):791-9.
48. Ippolito E, Farsetti P, Caterini R, Tudisco C. Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am. 2003 Jul;85- A(7):1286-94.
49. Ponseti IV. Treatment of congenital club foot. J Bone Jt Surg Am. 1992 Mar 1;74(3):448-54.
50. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am. 1995 Oct;77(10):1477-89.
51. Dobbs MB, Morcuende JA, Gurnett CA, Ponseti IV. Treatment of idiopathic clubfoot: an historical review. Iowa Orthop J. 2000;20:59-64.
52. Kite JH. Some Suggestions on the Treatment of Club Foot by Casts. J Bone It Surg Am. 1963 Mar 1;45(2):406-12.
53. The classic. Principles involved in the treatment of congenital clubfoot by J. Hiram Kite, M.D. reprinted from J. Bone Joint Surg. 21:595-606, 1939. Clin Orthop. 1972 May;84:4-8.
54. Lovell WW, Farley D. Treatment of congenital clubfoot. ONA J. 1979 Nov;6(11):453-6.
55. Stewart SF. Club-Foot: Its Incidence, Cause, and Treatment. J Bone .1t Surg Am. 1951 Jul I ;33(3):577-90.
56. Coss HS, Hennrikus WL. Parent satisfaction comparing two bandage materials used during serial casting in infants. Foot Ankle Int. 1996 Aug;17(8):483-6.
57. Pittner DE, Klingele KE, Beebe AC. Treatment of clubfoot with the Ponseti method: a comparison of casting materials. J Pediatr Orthop. 2008 Mar;28(2):250-3.
58. Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop. 2005 Oct;25(5):623-6.
59. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am. 2004 Jan;86-A(1):22-7.
60. Lourenco AF, Morcuende JA. Correction of neglected idiopathic club foot by the Ponseti method. J Bone Joint Surg Br. 2007 Mar;89(3):378-81.
61. Tindall AJ, Steinlechner CWB, Lavy CBD, Mannion S, Mkandawire N. Results of manipulation of idiopathic clubfoot deformity in Malawi by orthopaedic clinical officers using the Ponseti method: a realistic alternative for the developing world? J Pediatr Orthop. 2005 Oct;25(5):627-9.
62. Chen RC, Gordon JE, Luhmann SJ, Schoenecker PL, Dobbs MB. A new dynamic foot abduction orthosis for clubfoot treatment. J Pediatr Orthop. 2007 Aug;27(5):522-8.
63. Ponseti IV, Zhivkov M, Davis N, Sinclair M, Dobbs MB, Morcuende JA. Treatment of the complex idiopathic clubfoot. Clin Orthop. 2006 Oct;451:171-6.
64. Garg S, Dobbs MB. Use of the Ponseti method for recurrent clubfoot following posteromedial release. Indian J Orthop. 2008 Jan;42(1):68-72.
65. Dobbs MB, Gordon JE, Walton T, Schoenecker PL. Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity. J Pediatr Orthop. 2004 Aug;24(4):353-7.
66. Barker SL, Lavy CBD. Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot. J Bone Joint Surg Br. 2006 Mar;88(3):377-9.
67. Changulani M, Garg NK, Rajagopal TS, Bass A, Nayagam SN, Sampath J, et al. Treatment of idiopathic club foot using the Ponseti method. Initial experience. J Bone Joint Surg Br. 2006 Oct;88(10):1385-7.
68. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004 Feb;113(2):376-80.
69. Bensahel H, Catterall A, Dimeglio A. Practical applications in idiopathic clubfoot: a retrospective multicentric study in EPOS. J Pediatr Orthop. 1990 Apr;10(2):186-8.
70. Dimeglio A, Bonnet F, Mazeau P, De Rosa V. Orthopaedic treatment and passive motion machine: consequences for the surgical treatment of clubfoot. J Pediatr Orthop Part B. 1996;5(3):173-80.
71. Richards BS, Faulks S, Rathjen KE, Karol LA, Johnston CE. Jones SA. A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. J Bone Joint Surg Am. 2008 Nov;90(11):2313-21.
72. Van Campenhout A, Molenaers G, Moens P, Fabry G. Does functional treatment of idiopathic clubfoot reduce the indication for surgery? Call for a widely accepted rating system. J Pediatr Orthop Part B. 2001 Oct;10(4):315-8.
73. Bensahel H, Csukonyi Z, Desgrippes Y, Chaumien JP. Surgery in residual clubfoot: one-stage medioposterior release "a la carte." J Pediatr Orthop. 1987 Apr;7(2):145-8.
74. Abdelgawad AA, Lehman WB, van Bosse HJP, Scher DM, Sala DA. Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J Pediatr Orthop Part B. 2007 Mar;16(2):98-105.
75. Dietz F, Cole W, Tosi L, Carroll N, Wemer R, Comstock D, et al. A search for the gene(s) predisposing to idiopathic clubfoot. Clin Genet. 2005 Apr;67(4):361-2.
76. Porecha MM, Parmar DS, Chavda HR. Mid-term results of Ponseti method for the treatment of congenital idiopathic clubfoot--(a study of 67 clubfeet with mean five year follow-up). J Orthop Surg. 2011;6:3.
77. Garceau GJ, Manning KR. Transposition of the Anterior Tibial Tendon in the Treatment of Recurrent Congenital Club-Foot. J Bone Jt Surg Am. 1947 Oct 1;29(4):1044-8.
78. Fried A. Recurrent congenital clubfoot; the role of the M. tibialis posterior in etiology and treatment. J Bone Joint Surg Am. 1959 Mar;41-A(2):243-52.
79. Wainwright AM, Auld T, Benson MK, Theologis TN. The classification of congenital talipes equinovarus. J Bone Joint Surg Br. 2002 Sep;84(7):1020-4.
80. Tibrewal SB, Benson MK, Howard C, Fuller DJ. The Oxford club-foot programme. J Bone Joint Surg Br. 1992 Jul 1;74-B(4):528-33.
81. Scher DM, Feldman DS, van Bosse HJP, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop. 2004 Aug;24(4):349-52.
82. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am. 1995 Oct;77(10):1477-89.
83. Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop. 2002 Aug;22(4):517-21.
84. Lehman WB, Mohaideen A, Madan S, Scher DM, Van Bosse HJP, lannacone M, et al. A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop Part B. 2003 Mar;12(2):133-40.
85. Ponseti IV, Smoley EN. The Classic: Congenital Club Foot: The Results of Treatment. Clin Orthop. 2009 May;467(5): 1 133-45.
86. Thacker MM, Scher DM, Sala DA, van Bosse HJP, Feldman DS, Lehman WB. Use of the foot abduction orthosis following Ponseti casts: is it essential? J Pediatr Orthop. 2005 Apr;25(2):225-8.
87. Mootha AK, Saini R, Krishnan V, Bali K, Kumar V, Dhillon MS. Management of idiopathic clubfoot by the Ponseti technique: our experience at a tertiary referral centre. J Orthop Sci Off J Jpn Orthop Assoc. 2011 Mar;16(2):184-9.
88. Short term outcome of congenital clubfoot treated by Ponseti method [Internet]. Pakistan Journal of Medical Sciences. 2012 [cited 2015 Dec 6]. Available from: http://pjms.com.pk/index.php/pjms/article/view/ 1732
89. Chomiak J, Frydrychova M, Ostadal M, Matejicek M. [The Ponseti method of treatment of congenital clubfoot—first experiences]. Acta Chir Orthop Traumatol
90. Colburn M, Williams M. Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg. 2003 Oct;42(5):259-67.
91. Iltar S, Uysal M, Alemdaroglu KB, Aydogan NH, Kara T, Atlihan D. Treatment of clubfoot with the Ponseti method: should we begin casting in the newborn period or later? J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg. 2010 Oct;49(5):426-31.
92. Yagmurlu MF, Ermis MN, Akdeniz HE, Kesin E, Karakas ES. Ponseti management of clubfoot after walking age. Pediatr Int Off J Jpn Pediatr Soc. 2011 Feb;53(1):85-9.
93. Dogan A, Korkmaz M, Cengiz N, Kalender AM, Gokalp MA. Biomechanical comparison of Achilles tenotomy and achilloplasty techniques in young rats: an experimental study. J Am Podiatr Med Assoc. 2009 Jun;99(3):216-22.
94. Dobbs MB, Gordon JE, Walton T, Schoenecker PL. Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity. J Pediatr Orthop. 2004 Aug;24(4):353-7.
95. El-Mowafi H, El-Alfy B, Refai M. Functional outcome of salvage of residual and recurrent deformities of clubfoot with Ilizarov technique. Foot Ankle Surg Off J Eur Soc Foot Ankle Surg. 2009;15(1):3-6.
96. Ferreira RC, Costa MT. Recurrent clubfoot--approach and treatment with external fixation. Foot Ankle Clin. 2009 Sep;14(3):435-45.
97. Park S-S, Kim SW, Jung B-S, Lee HS, Kim JS. Selective soft-tissue release for recurrent or residual deformity after conservative treatment of idiopathic clubfoot. J Bone Joint Surg Br. 2009 Nov;91(11):1526-30.
98. Nogueira MP, Ey Bathe AM, Alves CG. Is it Possible to Treat Recurrent Clubfoot with the Ponseti Technique After Posteromedial Release?: A Preliminary Study. Clin Orthop. 2009 May;467(5): 1298-305.
99. Lehman WB. The clubfoot. New York: J.B.Lippincott; 1980 99. Ponseti IV. Congenital Clubfoot: Fundamentals of Treatment. New York: Oxford University Press, 1996.
100. Pirani S. A reliable and valid method of assessing the amount of deformity in the congenital clubfoot. St Louis, MO: Pediatric Orthopaedic Society of North America; 2004.
101. Elmslie RC. The principles of treatment of congenital talipes equinovarus. J. Orthop Surg. 1920;2:669.
102. Phelps AM. The present status of the open incision method for talipes equinovarus. New Engl. Med. Mon. 1891;10:217.
103. Jones R. Discussion on the treatment of intractable talipes equinovarus. Trans Brit Orthop Soc. 1895;1:20.
104. Percas-Ponseti H. Homage to Iowa: The inside story of Ignacio V. Ponseti. Iowa City, IA: The University of Iowa Press; 2007.
105. Sayre L. A Practical Manual of the Treatment of Clubfoot. New York, NY: D. Appleton and Company; 1869.
106. Bradford EH. Treatment of club-foot. J Bone Joint Surg Am. 1889;s1-1:89-115.
107. Taylor HL. The treatment of club-foot by continuous leverage. J Bone Joint Surg Am. 1893;s1-5:178-182.
108. Milliken FH. Treatment of infantile club-foot preliminary to operation. J Bone Joint Surg Am. 1890;s1-3:50-62.
109. Willard DF. Comparison of operative methods in the treatment of club-foot. J Bone Joint Surg Am. 1893;s1-5:225-231.
110. Ponseti IV, Smoley EN. Congenital club foot: The results of treatment. J Bone Joint Surg Am. 1963;45:261-275.
111. Ponseti IV, Campos J. Observations on pathogenesis and treatment of congenital clubfoot. Clin Orthop Relat Res. 1972;84:50-60.
112. Ponseti IV, Friedman B. Prognosis in idiopathic scoliosis. J Bone Joint Surg Am. 1950;32:381-395.
113. Ponseti IV. To Parents of Children Born with Clubfeet. Available at: http://www.uihealthcare.com/topics/medicaldepartments/ orthopaedics/clubfeet/. Accessed January 7, 2009.
114. Bechtol, C. 0 and Mossman, H. W.: Club-foot. An embryological study of associated muscle abnormalities, J. Bone Joint Surg. 32A:827, 1950.
115. Talipes equinovarus. A review of eighty-four cases after completion of treatment, J. Bone Joint Surg. 46B:464, 1964.
116. Browne, D.: Talipes equonovarus, Lancet ii:969, 1934.
117. Brockman, E. P.: Congenital Club-foot (Talipes Equinovarus), New York, William Wood and Co., 1930; pp. 1-59.
118. Dittrich, R. J.: Pathogenesis of congenital club-foot, J. Bone Joint Surg. 12:373, 1930.
119. Durante, G. and Courtillier, L.: Atrophic musculaire par regression embryonnaire totale chez un enfant atteint de pied bot paralytique congenital. Bull. Soc. Obst. Paris 2:366, 1899.
120. Hoffa, Albert: Lehrbuch der orthopaedischen Chirurgie, 5th ed. Stuttgart, Ferdinand Enke, 1905; p. 734.
121. Bolim, Max: Das menschliche Bein. Deutsche Orthopaedie, Band
122. Hirsch, C.: Observations on early operative treatment of congenital club-foot, Bull. Hosp. Joint Dis. 31:173, 1960.
123. Adams, W.: Club-foot: Its Causes, Pathology, and Treatment. London, J. and A. Churchill, 1866.
124. Irani, R. N. and Sherman, Mary S.: The pathological anatomy of clubfoot, J. Bone Joint Surg. 45A, No. 1, 1963.
125. Harris, H. A,: Posture in industry, Lancet ii:56, 1942.
126. Kite, J. H.: The treatment of congenital club-feet, Surg. Gynecol. Obstet. 61:190, 1935.
127. Huson, A.: Een Ontleedkundin-Functioneel Onderzoek van de Voetwortel. Leiden, Proefschrift, 1961.
128. Hicks, J. H.: The mechanics of the foot. J. Anat. Part I, 87:345; Part II, 88:25, 1953-54.
129. Ponseti, I. V. and Smoley, E. N.: Congenital club foot: The results of treatment, J. Bone Joint Surg. 45A:261, 1963.
130. Principles involved in the treatment of congenital club foot, J. Bone Joint Surg. 21:595, 1939.
131. Garceau, G. J. and Manning, K. R.: Transposition of the anterior tibial tendon in the treatment of recurrent congenital club-foot, J. Bone Joint Surg. 29:1044, 1947.
132. Spiegel DA, Shrestha OP, Sitoula P, Rajbhandary T, Bijukachhe B, Banskota AK. Ponseti method for untreated idiopathic clubfeet in Nepalese patients from 1 to 6 years of age. Clin Orthop Relat Res. 2008 Nov 6 [Epub ahead of print]
133. John Anthony Herring. Tachd Jian's pediatric orthopaedic. 4th ed. Saunders 2007: 1076-1086. 136. Pirani S, Outerbridge HK, Sawatzky B, Stothers K. A reliable method of clinically evaluating a virgin clubfoot evaluation.21stSICOT Congress 1999.

Dr Sudhir Ravindran