Features resisting primary treatment of congenital club foot.

The aims of this study were: (1) to see whether the number of relapses of hindfoot deformity in congenital club foot in the first year of life could be reduced by operative treatment, and (2) to try by surgery to pinpoint features of congenital club feet that make them resistant to treatment. As compared to treatment of 95 feet with manipulation and plaster cast only or with heel cord tenotomy added, early tenotomy of both the heel cord and the tibialis posterior tendon in 23 feet markedly reduced the number of relapses of hindfoot deformity, and the need for additional treatment. The results indicate that the achilles and the tibialis posterior tendons, and their corresponding muscles, are the main dynamic features that need to be dealt with when treating the hindfoot deformity in congenital club foot.